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LETTER TO THE EDITOR
Year : 2013  |  Volume : 8  |  Issue : 3  |  Page : 265
 

The importance of counseling in young, female epileptic patients


Department of Medicine, University of Leicester, Leicestershire, England, United Kingdom

Date of Web Publication26-Dec-2013

Correspondence Address:
Aravindhan Baheerathan
44, Brazil Street, Leicester, Leicestershire LE2 7JA, England
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.123720

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How to cite this article:
Baheerathan A, Selvaskandan H. The importance of counseling in young, female epileptic patients. J Pediatr Neurosci 2013;8:265

How to cite this URL:
Baheerathan A, Selvaskandan H. The importance of counseling in young, female epileptic patients. J Pediatr Neurosci [serial online] 2013 [cited 2019 Jun 26];8:265. Available from: http://www.pediatricneurosciences.com/text.asp?2013/8/3/265/123720


Dear Sir,

We would like to discuss the issue of condition awareness among young female epileptic patients, particularly with regards to preconceptual counseling and early medication reviews.

Women of child-bearing age account for 25% of epileptics, with many of them being managed by long-term antiepileptic drugs (AEDs). [1] Although the majority of epileptic women have a normal pregnancy and child birth, AEDs present an increased risk of morbidity and mortality to both mothers and their babies. One of the greatest risks posed by certain AEDs is teratogenicity, which can occur especially in the first trimester. [2] In fact the recommended first-line treatment for tonic-clonic seizures, sodium valproate, has been shown to confer the highest risk of teratogenicity of all AEDs. [3] In addition to this issue, it is now clear that polypharmacy significantly increases this risk of teratogenicity, with the use of two AEDs increasing the risk of birth defects by a factor of three. [3] It is thus imperative that drug therapy is optimized prior to conception, or at least at the earliest possible opportunity.

It is also important that patients are made aware of the pregnancy related risks of their condition, such as potential fatalities that may occur i.e., sudden unexpected death in epilepsy (SUDEP), the risks of AEDs, and the complications of breast feeding; so that they can be advised and managed appropriately. Preconceptual counseling is also an opportunity to implement preventative strategies. For instance 5 mg of folate daily, taken preconceptually to 13 weeks gestation (the crucial period of organogenesis) significantly reduces the risk of neural tube defects. This is important, as a baby born to an epileptic mother is at an increased risk of neural tube defects due to AEDs.

It thus becomes clear that issues surrounding pregnancy and epilepsy need to be addressed, and that this can be achieved through adequate counseling. This should be provided at an early age to all female patients, to empower them to seek advice when pregnancy is desired, and indeed to encourage the use of appropriate contraception when it is not. In this regard, the National Institute of Clinical Excellence (NICE) have published excellent guidelines that may be given to women planning to conceive, and should be used as a framework for clinical practice.

We recently completed an audit of all pregnant epileptics within our trust, assessing if appropriate advice had been issued either preconceptually, during pregnancy, or both. We found that whilst appropriate advice was given following conception, 0% of patients had come in for preconceptual medication reviews or counseling. One likely explanation for this may be that patients are unaware of the risks posed by AEDs and epilepsy during pregnancy. Thus, we recommend educating this cohort of patients (and their carers) from their early teens, allowing them to understand the importance of this issue. NICE guidelines can be used to provide a framework for this counseling, which would ensure that all major discussion points are covered. This simple intervention could play a pivotal role in reducing AED-related morbidity and mortality.

 
   References Top

1.Primary care guidelines for the management of females with epilepsy. Royal Society of Medicine; 2004.  Back to cited text no. 1
    
2.Burakgazi E, Harden C, Kelly JJ. Contraception for women with epilepsy. Rev Neurol Dis 2009;6:E62-7.  Back to cited text no. 2
[PUBMED]    
3.Tomson T, Battino D. Teratogenic effects of anti-epileptic drugs in pregnancy. Lancet Neurol 2012;11:803-13  Back to cited text no. 3
    




 

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