Women with epilepsy who are or wish to become pregnant have the added stress of keeping themselves - as well as their babies - safe throughout their pregnancy. Now, a new study recently published in The American Academy of Neurology's journal, Neurology, is shedding some light on medication dosage to help keep them safely seizure-free.
Epilepsy is a common, neurological seizure disorder that affects people of all ages. It is characterized by unpredictable seizures and can cause other health problems such as heart and respiratory conditions. Many people who live with this condition take antiepileptic drugs or AEDs. AEDs are usually taken once or twice a day, and work by altering and reducing the excessive electrical activity in the brain. AEDs do not stop seizures, however. They are merely a preventative measure.
During pregnancy, many women choose to continue taking AEDs, which are deemed safe. However, pregnancy can alter the way and rate that medications are metabolized and cleared, due to the numerous physiological changes that take place in a woman's body. Until now, experts were not certain if the effectiveness of AEDs were indeed altered during pregnancy.
"We want to be able to give the exact dose of a drug that keeps a woman seizure-free and keeps her and her baby safe, but there are relatively few studies that have examined pregnancy-related changes in AED metabolism for us to know how to adjust this dose," said lead author, Dr. P. Emanuela Voinescu, associate neurologist in the Department of Neurology at Brigham and Women's Hospital in Boston.
As part of the study, researchers followed 40 women with epilepsy who were planning to conceive or who were less than 16 weeks pregnant, and who chose to continue their AEDs during pregnancy. They visited the women every one to three months and for the first postpartum year and recorded the concentration of their AED medication by examining their bloodwork. They also recorded seizure occurrence and frequency.
They found that the clearance - the rate at which the active drug is removed from the body - of the most commonly used medication (levetiracetam) significantly changes by the first trimester of pregnancy. Additionally, they also found that the clearance of two other common medication changes by the second trimester. This was an important finding, because if drug clearance increases, patients may need to be prescribed a higher or more frequent dose of their antiepileptic medication to prevent seizures.
Voinescu added that this study highlighted the need for more scientific guidelines for women with epilepsy, specifically regarding "how to adjust medication doses during pregnancy to keep [women] seizure-free and to keep their babies safe."