Preconception Counseling

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If you have epilepsy and you are planning to have a baby, make an appointment to see your neurologist or epileptologist (a physician who specializes in the treatment of epilepsy) for preconception counseling before trying to become pregnant. Many important issues need to be discussed and understood before you become pregnant, some of which you may be aware of, but many of which you may not be. Unfortunately, women often wait until they are already pregnant before calling their doctor.

Preconception counseling can have a major positive impact on the health of mothers and babies. This usually involves meeting with an epilep-tologist and other medical professionals who are experienced in both epilepsy and pregnancy. Preconception counseling usually consists of an assessment of the health of both potential parents, although a greater emphasis is usually placed on the woman with epilepsy. It may also involve some medical tests.

Women who take antiepileptic drugs (AEDs) to control their seizures need to understand that the medication can affect the baby. They also need to consider the possible effects of not taking medication: seizures during pregnancy can possibly harm the mother and her fetus. Preconception counseling can help women become fully educated about the interactions between epilepsy, AEDs, and pregnancy.

This is a good time to talk about any changes in your epilepsy treatment that might be necessary. The baby's main organs and skeleton develop during the first 4 months of pregnancy, a period during which AEDs may affect the fetus the most. This is one of the major reasons your epilepsy treatment should be evaluated before you get pregnant.

If a pregnant woman is having seizures, her AEDs may be kept at the lowest dose that allows for the best control of her seizures. Women who are likely to have seizures during pregnancy are also generally advised to keep taking their AEDs; however, your physician may recommend changes in the type of medication or the dose. Do not change your AED dosage without consulting your doctor.

If a woman has been free of seizures for 2 to 3 years, she may be able to stop taking her AEDs slowly, but there is always a chance that her seizures will recur. This needs to be cautiously and well thought out before a decision is made. Having seizures could affect the woman's everyday life, and she could also lose her driver's license.

There will be no opportunity for preconception counseling if an unplanned pregnancy occurs. In this case, you should continue to take your AEDs and see your epileptologist as soon as possible.

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