Seizure Disorders

Epileptic women contemplating pregnancy who have not had a seizure for 5 years should consider a prepregnancy trial of withdrawal from treatment. Those with recurrent epilepsy should use a single drug with blood level monitoring. Trimethadione and valproate are contraindicated during pregnancy; phenytoin and carbamazepine may be teratogenic in the first trimester and should not be used unless absolutely necessary. There is limited information available on the safety of newer antiepilepsy drugs (eg, lamotrigine), and they should generally be avoided.

Phenobarbital is considered the drug of choice. Serum levels should be measured in each trimester and dosage adjustments made to keep serum levels in the low normal therapeutic range. Pregnant women taking phenobarbital and phenytoin should receive vitamin supplements, including folic acid and vitamin D, throughout pregnancy. Vitamin K, 10-20 mg/d, is administered during the last month to help prevent bleeding problems in the newborn, who is at risk of bleeding tendencies due to decreased levels of clotting factors. Such infants should receive an injection of vitamin K1, 1 mg subcutaneously immediately after delivery, and should have clotting studies 2-4 hours later. Breast feeding is not contraindicated for infants of mothers taking antiseizure medications.