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Epilepsy drug given the green light for use during pregnancy

A new study should provide good news to pregnant women who are taking the epilepsy drug levetiracetam and bad news for women taking the drug valproate
A new study should provide good news to pregnant women who are taking the epilepsy drug levetiracetam and bad news for women taking the drug valproate
Robin Wulffson, M.D.

When a woman becomes pregnant, she often takes steps to avoid ingesting any harmful substances; thus, she may avoid alcohol, smoking, or any medication that might harm her developing fetus. Some of these women are taking medication for a health problem such as epilepsy. Under these conditions, the risks versus the benefits of the medication must be assessed. A new study should provide good news to pregnant women who are taking the epilepsy drug levetiracetam and bad news for women taking the drug valproate. A new study has found that this drug appears to be safe for use during pregnancy. The study was published in the January 8 online issue of Neurology, the medical journal of the American Academy of Neurology by researchers at the University of Liverpool in the United Kingdom.

The study group comprised 53 children exposed to levetiracetam, 44 children whose mothers took the epileptic drug valproate and, 151 children whose mothers did not have epilepsy and did not take any drugs during pregnancy. The children were age three to four-and-a-half. Tests were conducted to evaluate their development in areas such as thinking, movement, and language abilities. The researchers found that children exposed to levetiracetam did not differ from children not exposed to epilepsy drugs on any of the tests that were administered. However, compared to children exposed to levetiracetam, children who were exposed to valproate scored an average of 16 points lower on movement tests, 10 points lower on expressive language tests, and six points lower on language comprehension measures.

Study author Rebekah Shallcross, PhD noted, “These results are heartening, as the use of levetiracetam has increased in recent years, but there has been limited information on its effect on the thinking, movement and language abilities of children. However this is the first study to look at the effects of levetiracetam and further research is needed before we can be certain there are no associations. It is very important that women do not stop taking their medication before speaking to their healthcare professional.”

Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent unprovoked seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races and ethnic background. According to the Epilepsy Foundation of America, nearly 3 million Americans live with epilepsy. Individuals who have repeated seizures usually need to take antiepileptic drugs. These drugs do not cure the disorder, but they can prevent seizures all or most of the time. There are more than 20 different antiepileptic drugs. The choice of drug is based on a patient’s age, the type of seizure, and the side effects of the drug. If one drug does not work, another can be tried. More than one drug may be needed to control seizures.

According to the American Congress of Obstetricians and Gynecologists (ACOG), seizure disorders can affect pregnancy in several ways:

  • Women with seizure disorders have a higher risk of having a child with a birth defect than women who do not have seizure disorders. This increased risk may be related to the seizure disorder itself or to some of the antiepileptic drugs used to treat it.
  • Having a seizure during pregnancy can cause injury to you and your baby.
  • Pregnancy can change the frequency of seizures. Most women will have no changes in seizure frequency or will have seizures less often. One third will have seizures more often. Many of these problems can be minimized or avoided by getting good medical care before and during pregnancy.

Risks are associated with having a seizure during pregnancy. Seizures can harm not only the woman, but also her baby. Seizures that cause a loss of consciousness and violent, jerking movements, called grand mal seizures, are especially hazardous during pregnancy. The risks associated with seizures during pregnancy include injury from falls, decreased oxygen to the baby during the seizure, preterm labor, and preterm birth.

Some antiepileptic drugs have been associated with a small increased risk of birth defects, including cleft lip or palate (the lip or roof of the mouth is not completely closed), heart defects, and neural tube defects. One reason why AEDs may be related to an increased risk of birth defects is that many of these drugs affect the way the body uses folic acid. Folic acid is a B vitamin. Not having enough folic acid before pregnancy and during the first weeks of pregnancy can increase the risk of having a child with a neural tube defect. If you take an antiepileptic drug, your healthcare provider may recommend that you take extra folic acid before pregnancy and for the first three months of pregnancy.

Because there are serious risks associated with having a seizure during pregnancy and because the potential risk of harm to your baby from taking antiepileptic drugs is small, experts recommend that seizures be controlled with antiepileptic drugs, if necessary, during pregnancy. However, the type, amount, or number of drugs that you take may need to change. Ideally, any Changes in medication should be made before pregnancy. This allows you and your healthcare provider to see how the medication changes affect you without putting the fetus at risk.