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Reader Remarks on:

Managing Pregnancy-Related Issues in Women with Epilepsy

• When to switch the AED
• Women with epilepsy
• Response to "When to switch the AED"

When to switch the AED

V.R. Quezada, 22 Jun 2009 12:44 PM EST

Competing interests: None declared

Considering that valproate, phenobarbital, and pheytoin are associated with poor cognitive outcomes (and VPA with neural tube defects) and thus avoided during preganancy, but are not considered to pass through the breastmilk--when would you switch a mother to one of these AEDs if they really want to breastfeed?

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Women with epilepsy

Dr Jude Osa Omoregie, St Jude Medical Centre Jattu, 6 Jul 2009 2:55 PM EST

Competing interests: None declared

I think this report is heart warming and should serve as a guide to all gynaecologists. It is however disheartning that those of us who practice in resource poor settings do nothave enough facilities and collaboration on drug choice for our women with epilepsy in pregnancy who we are seeing from time to time during antenatal care.

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Response to "When to switch the AED"

Kimford J. Meador, MD, Professor of Neurology, Emory University, 15 Sep 2009 3:47 PM EST

Competing interests: Author on WWE guideline panel for the American Academy of Neurology

I interpret your query to mean that the woman in question was already receiving valproate, phenobarbital, or phenytoin for her epilepsy, and was switched to another AED either before pregnancy or after she became pregnant. Having delivered her baby, she now wishes to breastfeed.

Although there are no data to address this particular situation, we have evaluated cognitive outcomes in children of women with epilepsy. All the children were exposed during their mother's pregnancy to either valproate, phenytoin, carbamazepine, or lamotrigine in monotherapy. About half of the children were breastfed. We found no adverse effects of AED use during breastfeeding beyond those suffered from the exposure during pregnancy. Based on these findings (as well as the known benefits of breastfeeding), I usually encourage my patients with epilepsy to breastfeed if they would like to do so. For the situation that you asking about where the AEDs are being changed after delivery before breastfeeding, we do not have any direct information. The three AEDs listed do pass into breast milk, but the amounts are not felt to be clinically significant. The decision to switch to one of these AEDs as well as the timing of the switch should be made on an individual basis in consultation with the woman's physician.

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