Epilepsy

Contraception

• If you take the combined oral contraceptive pill - the dose of the oestrogen part needs to be at least 50 micrograms. This is more than the usual dose. Also, many doctors recommend that:
  • You should take three packs together (tricycling). This means taking one pack after each other without a break between the three packs. Then have a 'pill free break' after the third pack.
  • When you do have a 'pill free break', only have four days break rather than the usual seven.
  • If you get breakthrough bleeding whilst taking the pill, the dose of oestrogen should be increased to 75-100 micrograms per day.
  Even with these extra precautions, the reliabilty of the pill is reduced compared to women who do not take medicines that are liver enzyme inducers. Therefore, some doctors advise that you use condoms in addtion to the pill for extra contraceptive protection.
• If you use the progestogen injection called Depo-provera for contraception - then you need an injection every 10 weeks. (This is more often than usual which is every 12 weeks.)
• The progestogen-only pill is not recommended.
• Progestogen implants are not recommended.
• The combined transdermal contraceptive patch is not recommended.
• If you use emergency contraception tablets - the initial dose of levonorgestrel should be increased to 1.5 mg followed by 750 micrograms 12 hours later.

Special consideration - lamotrigine and the pill

The 'take home message'

Pregnancy

Before becoming pregnant

• You may wish to discuss the relative benefits and risks of adjusting medication.
• If you have not had any seizures for some time, you may wish to consider stopping anti-epilepsy medication before becoming pregnant. Deciding to come off anti-epilepsy medication can be a difficult decision. Factors such as the type of epilepsy that you have can be important. For example, if you have the type of epilepsy that causes severe tonic-clonic seizures, there is a risk that you could have a severe seizure when you are pregnant if you stop your medication.
• All women taking anti-epilepsy medication are recommended to take 5 mg per day of folic acid before becoming pregnant, and continued until 12 weeks of pregnancy. Folic acid is recommended for all women who are pregnant, but the dose for women taking anti-epilepsy medicines is higher than usual. If you take folic acid tablets in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida.
• You may wish to discuss the question 'what are the risks that my child will also have epilepsy?'. In general, the probability is low that a child born to a parent with epilepsy will also have epilepsy. However, it can partly depend on your family history as some types of epilepsy run in families. Therefore, genetic counselling may be an option to consider if one partner has epilepsy, particularly if the partner has idiopathic epilepsy (epilepsy of unknown cause) and a family history of epilepsy.
• If you do become pregnant, you will be encouraged to notify your pregnancy to the UK Epilepsy and Pregnancy Register (see www.epilepsyandpregnancy.co.uk for details). This is a major ongoing research study that collects information about the safety of anti-epilepsy medicines in pregnancy.

Risk from seizures occurring during pregnancy

• If you have generalized tonic-clonic seizures, there is a small risk that a severe or prolonged seizure may harm the unborn baby. However, the risk is small, and the baby is not affected during most seizures. The risk of a tonic-clonic seizure during childbirth is low. However, to play safe, childbirth should take place in hospital with facilities for mother and baby resuscitation.
• If you have partial seizures, absence seizures, or myoclonic seizures, a seizure is not likely to cause harm to a baby (unless you fall and badly injure yourself).

Risk from anti-epilepsy medicines

• Overall, about 4 in 100 pregnant women who take one anti-epilepsy medicine have a baby with a birth defect. The risk rises to about 6-7 in 100 when taking two anti-epilepsy medicines.
• However, the risks from different medicines can vary. For example, the risk for sodium valproate is about 7 in 100 whereas the risk for carbamazepine is about 2 in 100 and the risk for lamotrigine is about 3 in 100. Therefore, if possible, sodium valproate is not prescribed to women who may become pregnant.
• Taking folic acid 5 mg daily (as discussed above) is thought to reduce the risk from anti-epilepsy medicines during pregnancy.
• Pregnant women who are taking anti-epilepsy medicines are usually offered a high-resolution ultrasound scan to screen for birth defects at 18-20 weeks pregnancy. However, earlier scanning may allow major birth defects to be detected sooner.
• If you have an unplanned pregnancy, do not stop your anti-epilepsy medication without advice which may put you at risk or having a seizure. However, see a doctor as soon as possible and start taking folic acid 5 mg daily straight away.

Breastfeeding

Further information

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