A rational antiepileptic drug therapy of epileptic women in child bearing age.

Some special considerations are necessary for epileptic women, since risks and difficulties during pregnancy, delivery and child care remain greater for epileptics than for nonepileptics. The complete control of seizures in the pregestational period and regular drug taking are very important. Periodical monitoring of the serum level of AED is necessary even if the epileptic seizure is controlled. If the serum level decreases, one must confirm the patient's compliance. Prevention of malformation can take place before the onset of pregnancy by decreasing the dose of the drug and/or changing from a combination of AEDs to a single drug. Thus, the preconceptional counseling is indispensable, and it should ensure that an epileptic embark upon a pregnancy with her epilepsy well controlled by a minimal dose of AEDs, and adequate answers to the questions raised by the patient should be given to prevent a poor compliance. Every epileptic pregnant woman should be seen at a well-equipped hospital or maternity center with adequate facilities and manpower. The antepartum and intrapartum fetal heart rate monitoring at each visit, and a prenatal diagnosis via maternal serum AFP and ultrasound are also suggested. A delay in the physical development of the offspring may be transient. The psychomotor development of the offspring is much more dependent on the child-care environment suggesting the necessity of help from the other family members if the mother cannot nurse properly.