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New guidelines published for treating women with epilepsy

9 November, 2004

The UK Royal Society of Medicine
has published new primary care guidelines for the management of women
with epilepsy. Produced following a meeting of epilepsy experts, the
guidelines cover such topics as the diagnosis and treatment of
epilepsy, preconception counselling and the management of epilepsy
during and after pregnancy.

The
guidelines advise that, generally speaking, GPs [family doctors] should
not be responsible for starting or changing anti-epileptic drugs
(AEDs). It advises that GPs need to be familiar with the issues
surrounding the choice of medication in women but stress that patients
‘must be referred to a specialist within 28 days' to prescribe and
monitor treatment. The guidelines group give the following advice to
GPs on the management of females with epilepsy who may become pregnant:

  • GPs
    should introduce pre-conceptual issues to women of childbearing age
    soon after diagnosis and at every review, well in advance of when a
    woman may be planning to start a family, and these should be raised at
    every opportunity and documented as having been discussed
  • Women
    with epilepsy should be reassured that if they decide to have children,
    their pregnancies, although medically complicated, are likely to be
    uneventful and they are likely to deliver healthy babies
  • The
    choices of drug should never be presented as being either ‘perfect' or
    ‘harmful' as the ‘perfect' drug may prove unsuitable and others may
    have to be tried.
  • GPs
    should advise that although sodium valproate is the anti-epileptic of
    choice in patients with certain types of epilepsy, women taking sodium
    valproate during pregnancy appear to have a significantly increased
    risk of having a child with major malformations compared with those
    women taking carbamazepine or lamotrigine
  • Therefore,
    women of childbearing potential should not be started on sodium
    valproate without specialist neurological advice, and should only take
    the drug if no other treatment can control her seizures. Changes in
    type of AEDs should only be made on specialist advice and there should
    be no abrupt changes to or withdrawal from medication
  • If
    a woman has been seizure-free for 2-3 years, she should be offered the
    opportunity to discuss with a specialist the gradual withdrawal of her
    AED medication even though this may affect lifestyle issues

Professor Ley Sander, from the Institute of Neurology, said:

'These
guidelines address a very topical issue and will help GPs to optimise
the treatment of women with epilepsy. It is important that a balance is
struck between the risks and benefits of epilepsy treatments."