AAN, AES and SMFM Collaborate to Develop
Updated Guidance
MINNEAPOLIS, May 15, 2024 /PRNewswire/ -- A new guideline has
been issued to help neurologists and other clinicians determine the
best antiseizure medications for people with epilepsy who may
become pregnant. The guideline is published in the May 15, 2024, online issue of
Neurology®, the medical journal of the
American Academy of Neurology (AAN), and was developed through
a collaboration between the AAN, the American Epilepsy Society
(AES) and the Society for Maternal-Fetal Medicine (SMFM). It was
endorsed by the Child Neurology Society.
The guideline partially updates two 2009 AAN and AES
guidelines on the management of epilepsy during pregnancy,
specifically regarding malformations at birth and the development
of children born to people with epilepsy.
"Most children born to people with epilepsy are healthy, but
there is a small risk of pregnancy-related problems, partly due to
seizures and partly due to the effects of antiseizure medications,"
said author Alison M. Pack, MD, MPH,
of Columbia University in New York City, a Fellow of the American
Academy of Neurology and a member of the American Epilepsy Society.
"This guideline provides recommendations regarding the effects of
antiseizure medications and folic acid supplementation on
malformations at birth and the development of children during
pregnancy so that doctors and people with epilepsy can determine
which treatments may be best for them."
The guideline recommendations are based on a review of all
available evidence on the topic. Risks can include major congenital
malformations, or birth defects, fetal growth issues and
neurodevelopmental effects such as autism or lower IQ scores.
The guideline states when treating people with epilepsy who may
become pregnant, doctors should recommend medications and doses
that optimize both seizure control and fetal development at the
earliest possible opportunity before pregnancy.
During pregnancy, it recommends minimizing the occurrence of
tonic-clonic seizures, seizures with full body spasms, to minimize
risks to the parent and fetus. It also says stopping medications
during pregnancy may increase the frequency of seizures, which may
harm the parent and fetus.
For medications, the guideline recommends using lamotrigine,
levetiracetam or oxcarbazepine when appropriate to minimize risk of
major birth defects.
It recommends avoiding valproic acid, phenobarbital and
topiramate when possible. To reduce the risk of poor
neurodevelopmental outcomes, including autism spectrum disorder and
lower IQ scores, the guideline recommends clinicians avoid
prescribing valproic acid, when possible, to people with epilepsy
who may become pregnant.
The guideline recommends that people with epilepsy who may
become pregnant take at least 0.4 milligrams of folic acid
daily before and during pregnancy to decrease the risk of neural
tube defects and possibly improve neurodevelopmental outcomes.
However, it notes further studies are needed to clarify the optimal
dose and timing of folic acid supplementation.
"People with epilepsy who may become pregnant want to ensure the
best health of their child while still managing and minimizing
their seizures," said Pack. "This is why it is important to discuss
plans for pregnancy with your doctor before becoming pregnant and
notify your doctor as soon as possible if you discover you are
pregnant. Don't stop or change your medications. Talk with your
doctor about any concerns you have about your medications."
There are some medications that did not have enough evidence to
be evaluated and need more research about their associated
risk.
The guideline was funded by the American Academy of
Neurology.
About the American Academy of Neurology
The American
Academy of Neurology is the world's largest association of
neurologists and neuroscience professionals, with over 40,000
members. The AAN's mission is to enhance member career fulfillment
and promote brain health for all. A neurologist is a doctor with
specialized training in diagnosing, treating and managing disorders
of the brain and nervous system such as Alzheimer's disease,
stroke, concussion, epilepsy, Parkinson's disease, multiple
sclerosis, headache and migraine.
For more information about the American Academy of Neurology,
visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn
and YouTube.
About the American Epilepsy
Society
Founded in 1936, the American Epilepsy Society
is a medical and scientific society whose members are dedicated to
advancing research and education for preventing, treating and
curing epilepsy. AES is an inclusive global forum where
professionals from academia, private practice, not-for-profit,
government and industry can learn, share and grow to eradicate
epilepsy and its consequences.
About the Society for Maternal-Fetal Medicine
(SMFM)
The Society for Maternal-Fetal Medicine (SMFM),
founded in 1977, is the medical professional society for
maternal-fetal medicine subspecialists, who are obstetricians with
additional training in high-risk pregnancies. SMFM represents more
than 7,000 members who care for high-risk pregnant people and
provides education, promotes research, and engages in advocacy to
advance optimal and equitable perinatal outcomes for all people who
desire and experience pregnancy. For more information,
visit SMFM.org.
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SOURCE American Academy of Neurology