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Special Considerations
for Women with Epilepsy

First Page | Second Page

Mark S. Yerby M.D., M.P.H.
Clinical Associate Professor of Neurology, Public Health and Ob-Gyn
Oregon Health Sciences University

TABLE 1
RATES OF CATAMENIAL EPILEPSY

AUTHOR	N	PERCENT CATAMENIAL SEIZURES
Dickerson, 1941	269	10
Ansell & Clarke, 1956	42	63
Laidlaw, 1956	50	72
Lennox & Lennox	686	49
Rosciszewska, 1980	69	58
Marquez-Assis, 1981	1574	23
Duncan, 1993	40	12

TABLE 2
INCREASED RISKS OF PREGNANCY AND EPILEPSY

Effects on Epilepsy	Complications of Pregnancy	Complications in the Offspring
Increased seizure frequency	Vaginal hemorrhage Microcephaly Anemia	Mal-development Anomalies
Declining drug levels	Malformations Death	Hyperemesis gravidarum
Alteration of drug pharmacokinetics	Toxemia Induced labor Premature rupture of membranes	Stillbirth Neonatal death Perinatal death Hemorrhagic disease
Others	Cesarean section Seizures Drug withdrawal Hypoxia	Low birth weight Prematurity Feeding difficulties

TABLE 3
EFFECT OF PREGNANCY ON SEIZURE FREQUENCY

Percentage of Change in Seizure Frequency

Investigator	n	Increased	None	Decreased
Nerlinger 1889	--	36	12	36
Rubesca 1911	--	33	33	33
Baptisti 1938	34	24	62	15
Burnett 1946	19	42	53	6
Sabin & Oxorn 1956	55	33	52	15
Suter & Klingman 1957	93	46	46	8
Zlatkis 1966	43	75	16	9
Maroni & Markott 1969	31	24	73	3
Rosciszewska & Grudzinska 1970	29	24	28	48
Knight & Rhind 1975	84	45	50	5
Canger et al. 1981	--	41	50	9
Schmidt et al. 1983	136	37	50	13
Svigos 1984	74	24	--	--
Otani 1985	110	23	50	7

TABLE 4
POSSIBLE CAUSES OF INCREASED SEIZURE FREQUENCY IN PREGNANCY

Hormonal:	Increase in serum estrogens
Metabolic:	Increased water and sodium retention Alkalosis secondary to hyperventilation
Psychological:	Increased stress and anxiety Reduced medication compliance
Pharmacokinetic:	Decrease in serum anticonvulsant levels
Physiological:	Sleep deprivation

TABLE 5
PHARMACOKINETIC DATA

Anticonvulsant	Percent Decrease in Total Level by 3rd Trimester	Percent Free Fraction Normal Maternal Neonatal
Carbamazepine	40%	22%	25%	35%
Ethosuximide		90%	?	?
Phenobarbital	55%	51%	58%	66%
Phenytoin	56%	9%	11%	13%
Primidone	55%
Derived Phenobarbital	70%	75%	80%	?
Valproic Acid	50%	9%	15%	19%

TABLE 6
STILLBIRTH AND NEONATAL DEATH RATES
IN INFANTS OF EPILEPTIC MOTHERS

Investigator	Stillbirths % Cases   Controls		Neonatal Deaths % Cases   Controls
Janz 1964	12.1	7.0	1.3	---
Spiedel & Meadow 1972	1.3	1.2	2.7	1.0
Bjenkdal & Bahna 1973	5.3	7.8	3.2	1.5
Fedrick 1973	2.7	1.1	---	---
Higgins & Comertond 1974	5.2	--	7.8	3.9
Knight & Rhind 1975	2.0	--	2.9	---
Nakane 1979	13.5	4.3	---	---
Nakane 1980	14.0	6.7	---	---
Nelson & Ellenberg 1982	5.1	1.9	3.5	2.7
Svigos 1984	0	1.3	---	---
Kalen 1986	2.2	---	2.7	---
Tanganelli & Regesta 1992	---	---	2.2	1.4

TABLE 7
SUMMARY OF RISKS OF PREGNANCY
FOR WWE TAKING ANTICONVULSANTS

33%	Risk of increase in seizure frequency
5%	Risk of vaginal bleeding
4-6%	Risk of malformed child
1%	Risk of spina bifida, if taking valproic acid
0.5%	Risk of spina bifida, if taking carbamazepine
10%	Risk of neonatal hemorrhage, if no vitamin K supplement
1 - 6%	Risk of developmental delay

Bibliography for this article

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Special Considerations
for Women with Epilepsy

First Page | Second Page

Mark S. Yerby M.D., M.P.H.
North Pacific Epilepsy Research
Mother Joseph Plaza
9427 SW Barnes Road - Suite 595
Phone: 503-291-5300
Fax: 503-291-5303

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