UK HealthCast: Managing seizures in women of reproductive age

UK HealthCast is a podcast series featuring interviews with UK HealthCare experts on a variety of health-related topics, from how to recognize stroke symptoms to what patients need to know about clinical trials – and more.

On this edition of UK HealthCast we were joined by Dr. Sally Mathias, neurologist and epileptologist at the Kentucky Neuroscience Institute. Dr. Mathias discussed management of epilepsy and seizures in women of reproductive age.

How common are these conditions in women of reproductive age?

Very common, actually. Nearly 1.5 million women of childbearing age in the U.S. live with epilepsy and each year approximately 24,000 women with epilepsy give birth.

Can you walk us through the management of epilepsy and seizures for these women?

I would start off by saying the most important thing is planning a pregnancy and I would divide this into three important points. First is seizure control. The American Academy of Neurology and the American Epilepsy Society practice guidelines state that seizure freedom for at least nine months prior to becoming pregnant is associated with a high likelihood (almost 92 percent) of remaining seizure-free during pregnancy. So, I emphasize this to the patients and I say that our goal is to get you seizure-free or reduce the burden of your seizures before you get pregnant, because that determines what happens during pregnancy.

The second aspect of this is medication safety. One thing that I tell women who come to me for preconception counseling is you have to be on a safe anti-seizure medicine. And when I say safe, it is relatively safe. All anti-seizure medicines cause a slightly higher likelihood of birth defects in the baby. But among the ones that we have, we have to choose medications that are relatively safe. So, we try to make sure patients are on a relatively safe anti-seizure meds.

And the third and most important point, because so many pregnancies happen unplanned, is the use of folic acid. Folic acid will reduce the chances of neural tube defects. These are birth malformations of the brain and spinal cord, number one. And, number two, a most recent study has shown that supplementation of folic acid is actually associated with a higher IQ in children at age three and six. So, there are so many reasons to be on folic acid.

Could you lay out some parenting basics for us, including breastfeeding and caring for the newborn?

This aspect is so important and there is so much misinformation about breastfeeding in particular. Breastfeeding is safe and recommended with almost every anti-seizure medication. There is only one main exception, and that's benzodiazepines. When my patients are on medications like clobazam, clonazepam, lorazepam, you know, that family of medications, I usually tell them not to breastfeed because it can lead to some sleepiness in the baby. But with every other medication, the amount that goes through the breast milk to the baby is far less compared to what the baby is exposed to in utero. Therefore, I tell the mom, if you want to breastfeed, go ahead.
 

The one rule that I'm very strict about is a mom or a dad with epilepsy should not give their newborn baby a submerged bath. That's one rule that I'm very strict about. Very little water is enough to drown the baby. Until the baby is able to sit by himself or herself, try not to give a submerged bath.

The other simple things are changing the baby on a lower surface, such as a carpeted floor instead of a high diaper changing station, avoiding stairs, avoiding front or back carriers if patients have very frequent seizures. But otherwise, most women get through this postpartum period really well.

One other important thing is sleep deprivation. It is so natural after having a newborn and sleep deprivation in fact is one of the triggers for seizures. I advise my patients to seek support from their significant others, from their family members, so that they can get some help at night with the baby, so that they can have an uninterrupted sleep for a few hours.

Listen to our entire podcast with Dr. Mathias: