The effect of pregnancy on seizure control and antiepileptic drugs in women with epilepsy.

Epilepsy is one of the most common neurologic conditions seen by obstetricians, primary care physicians, and neurologists. It is present in three to five per 1000 births, and most women with epilepsy (WWE) can expect to have a normal pregnancy and delivery. The clinician's goal is to establish the best seizure control with the fewest possible number of antiepileptic drugs (AEDs) prior to pregnancy. Clinicians need to be aware of how the pharmacokinetic features of AEDs change during the pregnancy and postpartum period. During pregnancy AED concentrations may decrease, thereby increasing the risk of seizure deterioration. Levels of some AEDs must be monitored and the doses adjusted routinely during pregnancy and after birth. Understanding and applying these principles will ensure better seizure control during and after pregnancy and minimize the risk to the mother and the fetus due to recurrent seizures and fluctuating AED levels. This review emphasizes significant changes in pharmacokinetics of AEDs, the importance of monitoring serum concentration of AEDs, and routine dose adjustment prior to conception and during pregnancy and the postpartum period.