Department of Neurology

Antiepileptic drug therapy and pregnancy

Q: I am having concerns regarding pregnancy and antiepileptic drugs. I am currently on Tegretol XR and was under the impression that it is the "best" drug to be on., however my current doctor told me that phenobarb is. Any ideas???

A: The answer to which medications to use during pregnancy is complex. All of the antiepileptic drugs are believed to increase the risk of birth defects, and even having epilepsy alone appears to increase the risk. Most epileptologists recommend that patients who become pregnant remain on whatever drug regimen best controls their epilepsy. Stopping medications is not a good approach, since the risk for injury in persons with uncontrolled seizures is high. Worse yet, abrupt cessation of seizure medications can lead to status epilepticus (continuous seizures) that could even cause death. Although it was once believed that phenobarbital was the "safest" seizure medication for pregnancy, there is no data to support this belief.

The best approach is to plan ahead of time and make sure all physicians involved (neurologist, obstetrician and primary care physician) are aware of the intended pregnancy in advance. This will allow them to minimize seizure medications, start prenatal vitamins prior to conception, and establish good prenatal care.

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