Preconception counseling for women with epilepsy

Key points: More than half of women with epilepsy (WWE) do not recall being counseled on antiepileptic drugs (AEDs) and teratogenicity Preconception counseling should be started early and revisited frequently for WWE of childbearing ageThe majority of WWE are likely to have a safe pregnancy and a healthy newbornCommonly discussed topics include transmission of epilepsy from mother to child, teratogenicity of AEDs, and seizure exacerbation in pregnancyUnder ideal circumstances, pre-partum optimization of AEDs should be done 9–12 months before a planned pregnancy, as seizure pattern in the year prior to conception is the best predictor of seizure frequency during pregnancy Introduction It is critical that WWE receive regular counseling about pregnancy and contraception from their physicians. Both seizures and AEDs pose risks to a pregnancy, which must be carefully discussed with WWE. Additionally, the epilepsy and AED-related risks can be significantly reduced by early and careful planning. Unfortunately, patient surveys demonstrate that less than half of WWE recall being counseled on tetratogenic effects of AEDs or the need to plan pregnancy [1, 2], and many are misinformed [3]. Most patients feel that when the topic is discussed, it is more likely to be raised by the patient herself rather than her physician [4]. Without effective counseling women are liable to either over- or underestimate the risks to a potential pregnancy.