Epilepsy, pregnancy and breastfeeding: Dr. Page Pennell

05/02/22 • 33 min

Can women with epilepsy get pregnant, give birth to healthy babies, and breastfeed? What are the myths and misconceptions around epilepsy during pregnancy, and what do physicians and women need to know? Dr. Anca Arbune interviews Dr. Page Pennell about the latest research and knowledge.

Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no longer a barrier to giving birth. The vast majority of women will have good outcomes.

Fertility issues are not a given in women with epilepsy, though they may arise in men or women taking enzyme-inducing anti-seizure medications.

A long history of taking anti-seizure medication does not affect a woman’s fertility or other outcomes. Only the type of medication taken during pregnancy can exert an influence. Significant reductions in the use of valproate in women of childbearing age mean that most women are taking anti-seizure medications that have lower risks to their babies.

A planned pregnancy with consistent seizure control can lead to safe and healthy outcomes. Certain anti-seizure medications require monitoring during pregnancy, due to changes in physiology and hormone levels.

Breastfeeding is safe and studies show beneficial effects to the infant, similar to those in infants in the general population.

Research discussed during the episode:

MONEAD (Maternal Outcomes and Neurodevelopmental Effects of Anti-epileptic Drugs) Study

Two-Year-Old Cognitive Outcomes in Children of Pregnant Women With Epilepsy in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study (2021) JAMA Neurology (KJ Meador, MJ Cohen, DW Loring, et al.)

Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study (2013) The Lancet Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiseizure Medication Concentrations During Pregnancy: Results From the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) Study (2022) JAMA Neurology (PB Pennell, A Karanam, KJ Meador, et al.)

Effects of breastfeeding in children of women taking antiepileptic drugs (2010) Neurology (KJ Meador, GA Baker, N Browning, et al.)

Antiepileptic Drug Exposure in Infants of Breastfeeding Mothers With Epilepsy (2019) JAMA Neurology (AK Birnbaum, KJ Meador, A Karanam, et al.)
This episode was reported by Dr. Anca Arbune, and edited and produced by Nancy Volkers.

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Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.
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The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Women with epilepsy were once counseled to avoid pregnancy, but epilepsy is no longer a barrier to giving birth. The vast majority of women will have good outcomes.

Fertility issues are not a given in women with epilepsy, though they may arise in men or women taking enzyme-inducing anti-seizure medications.

Breastfeeding is safe and studies show beneficial effects to the infant, similar to those in infants in the general population.

Research discussed during the episode:

MONEAD (Maternal Outcomes and Neurodevelopmental Effects of Anti-epileptic Drugs) Study

Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study (2013) The Lancet Neurology (KJ Meador, GA Baker, N Browning, et al.)

Effects of breastfeeding in children of women taking antiepileptic drugs (2010) Neurology (KJ Meador, GA Baker, N Browning, et al.)

ILAE is a

Previous Episode

"Why are there so many people?" - Seizures in the Canadian Arctic

Could annual dramatic shifts in day/night patterns in the Arctic have an effect on seizures? One researcher went looking for answers – and found more than he bargained for. His research revealed a public health crisis in one of the wealthiest countries in the world, highlighting the needs of geographically isolated communities and Indigenous peoples. (He also found intriguing results to his original question.)
Dr. Marcus Ng reviewed 11 years of data on emergency evacuations from the Kivalliq region of northern Canada. There, anyone who has seizures that last more than 5 minutes - an emergency condition known as status epilepticus - is helicoptered to a single hospital in Winnipeg, Manitoba.
Dr. Ng wondered if the frequency of evacuations changed as the seasons changed. Were people more likely to have seizures in the 24-hour darkness of winter, the 24-hour daylight of summer, or somewhere in between?
He found that the people of the Kivalliq region had the highest reported incidence of status epilepticus in the world, far higher than Canada's overall estimates. His research also revealed the barriers to timely care faced by this population.
This episode was reported and produced by Nancy Volkers. Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.
Studies mentioned or used as sources of information:
Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight. Epilepsia Open 2021

Circannual incidence of seizure evacuations from the Canadian Arctic. Epilepsy & Behavior 2022

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study. Epilepsy & Behavior 2019

Addressing provider turnover to improve health outcomes in Nunavut. Canadian Medical Association Journal 2019
Contact ILAE with feedback or episode ideas at [email protected]

Next Episode

Epigenetics in epilepsy and the Michael Prize: Dr. Katja Kobow

Katja Kobow is the most recent winner of the Michael Prize, an international award in epilepsy research. Her work focuses on epigenetics and epilepsy, a field that has grown exponentially in only the past 10 to 15 years. Dr. Kobow talked about her research and its potential for epilepsy diagnosis and treatment.

Epigenetics is the bookmarking system or the data management system of our genome. It decides which part of the genome is read, and when to read it. The epigenome is what makes the genome versatile in terms of regulating gene expression.

Epigenetics is crucial for all aspects of brain development and function. It’s also reversible, which has exciting implications for anti-epileptogenic therapies.
Dr. Kobow is assistant professor at the Institute of Neuropathology at the University Hospital Erlangen, Germany.

Selected recent publications:

DNA methylation-based classification of malformations of cortical development in the human brain (Acta Neuropathologica, 2022)

Molecular diagnostics in drug-resistant focal epilepsy define new disease entities (Brain Pathology, 2021)

Epigenetics explained: a topic “primer” for the epilepsy community by the ILAE Genetics/Epigenetics Task Force (Epileptic Disorders, 2020)

The Michael Prize is awarded in odd-numbered years; entries for the 2023 prize are now open and accepted until December 31, 2022.

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This episode was reported, edited, and produced by Nancy Volkers.

Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.
ILAE website | Facebook | Instagram
Twitter feeds: English | French | Japanese | Portuguese | Spanish | ILAE-YES

Sharp Waves: ILAE's epilepsy podcast - Epilepsy, pregnancy and breastfeeding: Dr. Page Pennell

Transcript

Dr. Arbune: Hello – thank you so much for meeting me. Could you please introduce yourself for our listeners and tell us your main research interests?

Dr. Pennell: I’m Page Pennell; I am a professor of neurology and chair of the Department of Neurology at the University of Pittsburgh School of Medicine.