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EEC 2022 | Treating women with epilepsy before, during, and after pregnancy: a practical guide

Bruna Nucera, MD, Hospital of Merano, Merano-Meran, Italy, outlines her work on a practical guide to the treatment and care options available for women with epilepsy before, during, and after pregnancy. Before pregnancy, it is important to explain to female patients that pregnancies should be carefully planned and folic acid should be taken for optimal outcomes for the mother and child. There is still not a consensus on how much folic acid should be administered. During pregnancy, antiseizure medication, such as valproate, can increase malformation risk. Changes in drug metabolism during pregnancy and postpartum are an additional important consideration. The overall aim is to correct the level of anti-seizure medication for it to be safe for both mother and child, taking into account teratogenic risks, the goal of seizure freedom, and up-titration requirements. Regarding breast feeding, gynecologists often recommend that the extra exposure to anti-seizure medication during this time is negative on the child’s health. Nonetheless, breastfeeding is an important stage for psychological bonding between mother and child and several antiseizure medications are thought to be safe in this setting. This interview took place at the 14th European Epilepsy Congress (EEC) 2022 in Geneva, Switzerland.