[Epilepsy and pregnancy].

Epilepsy affects almost 1% of all pregnant women. The effect of pregnancy upon epilepsy is unpredictable for the individual patient. In one third to one half of the patients epilepsy had no effect on seizure frequency, in one fourth to one third of the patients seizure frequency increased, and in one third to one fourth it improved. Several reasons are discussed for a frequently observed tendency to a drop in plasma concentration of antiepileptic drugs during pregnancy where the daily dose was kept unchanged. For unknown reasons, perinatal lethality is up to twice as high as in controls. The risk of bearing children with malformations is approximately 1.5-3 times higher for mothers with epilepsy than in non-epileptic mothers. Apart from antiepileptic drugs the role of genetic factors, the type and severity of epilepsy and the possible influence of grand-mal seizures during pregnancy must be considered to be involved in congenital anomalies. Polypharmacy produces more frequent anomalies than monotherapy. Valproate should be avoided in the pregnant women due to the increased incidence of neural tube defects. At this time there is no reason to discourage a mother on antiepileptic drug therapy from breast feeding.