University of Maryland Physicians Play Key Role in Evaluating Best Treatments
Women with epilepsy who want to get pregnant can do so safely, as long as they are cautious to avoid one particular drug that may cause higher rates of birth defects. That is the main finding of new epilepsy guidelines for women developed by the American Academy of Neurology and the American Epilepsy Society. The guidelines will be published in the April 27, 2009, online issue of Neurology, the medical journal of the American Academy of Neurology.
"Women who have epilepsy should feel assured that they can have a safe pregnancy without increased risk of Caesarean section, premature delivery or other complications," explains Jennifer Hopp, M.D., an assistant professor of neurology at the University of Maryland School of Medicine who is one of the authors of the new treatment guidelines.
"What's exciting about the findings is that they focus specifically on how epilepsy medications affect women, who have some different health concerns from men. We examined how these drugs could specifically affect a range of women's health issues from bone density to birth defects, and we found some areas of concern," adds Dr. Hopp, who is a neurologist and epilepsy specialist at the University of Maryland Medical Center.
The guidelines recommend that pregnant women with epilepsy should avoid taking the commonly used drug valproate due to an increased risk for fetal deformities and decreased cognitive skills in children. This higher risk was seen whether the drug was used by itself or in combination with other medications. The neurologists also found that these women should work with their doctors to limit the number of medications taken during pregnancy since taking more than one seizure medication also showed an increased risk for birth defects.
"Our extensive review of the best scientific studies indicates that women with epilepsy can have a safe pregnancy. However, we advise that they still consider having their blood tested regularly. Levels of anti-seizure medicine in the blood tend to fall during pregnancy. To ensure these women remain seizure-free, the medication doses may need to be adjusted throughout the pregnancy," says guideline author Allan Krumholz, M.D., director of the University of Maryland Epilepsy Center and professor of neurology at the University of Maryland School of Medicine.
The guideline also cautions physicians about prescribing the drugs phenytoin and phenobarbital to women who are pregnant, because of the potential risk of decreased cognitive skills in children. Additionally, pregnant women with epilepsy should not smoke because it may increase the risk of premature contractions and premature delivery.
"Because of their seizures and worries about medications, many women with epilepsy have been fearful of becoming pregnant. These new guidelines, rooted in strong scientific research, should help allay these concerns," adds guideline author Tricia Ting, M.D., assistant professor of neurology at the University of Maryland School of Medicine and a neurologist at the University of Maryland Medical Center.
Epilepsy is a neurological condition that causes recurrent seizures, affecting about 40 million Americans, including an estimated 500,000 women of childbearing age. The new epilepsy guidelines will be presented April 27, 2009, at the American Academy of Neurology's annual meeting in Seattle.
"Involvement in important projects such as this reflects the University of Maryland School of Medicine's commitment to advancing the practice of medicine. These guidelines will help women have the best information for a healthy pregnancy," says E. Albert Reece, M.D., Ph.D., M.B.A, vice president for medical affairs, University of Maryland, and dean, University of Maryland School of Medicine.
The University of Maryland Epilepsy Center offers comprehensive evaluation and treatment for people with epilepsy, including clinical research into new anti-seizure medications. University of Maryland physicians also provide epilepsy care for patients at the Baltimore VA Medical Center.
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