Women with epilepsy have double the rate of major fetal malformations than the general public. And again, I would point out that this is thought to be probably more related to medication than anything else, although there may be other factors that we don't understand. But I point out that if you know, if you double a small number, it's still a small number. So if the general population, about two to 3% of all women have children with made her major fetal malformations, cleft palate, heart malformations or Spina Bifida. So 2 to 3% of all women in women with epilepsy, it's 4 to 6%. So 94 to 96% of all women have perfectly healthy, normal babies. Things that we need to pay attention to though are the medications that they're on and the doses and how many medications they're on. And we know that there are a couple of medications that are specifically more problematic in women who are going to get pregnant. The first and foremost the drug that is the most problematic is depakote. Highest rate of fetal malformation, specifically Spina Bifida. And so women of childbearing age, generally, we want them off of Depakote, if at all possible. Sometimes it's not possible, but we certainly try our hardest. And there's another one called topiramate. Topiramate is a drug that's been associated with cleft palate. And so that's another one that we try to avoid if we can. Often women of childbearing age are on folic acid. The folic acid is given specifically for prevention of birth defects. Nobody knows how much folic acid is the right amount. Often we'll prescribe two milligrams, but if someone's actually actively trying to get pregnant up it to four milligrams. It's a water soluble vitamin, and whatever you don't need you'll pee right out. And so, specifically hormonal changes, changes with menstrual cycle and pregnancy are two specific issues that have to be addressed with women, and are incredibly important not to forget. And we often do, it just gets brushed over. No one asks, but worth talking about.
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