Choice of anti-epileptic drug may make a difference to unborn babies, UK

Main Category: Epilepsy
Article Date: 26 Oct 2005 - 0:00 PDT

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Data collected from a register of pregnant women with epilepsy show that almost 96% of babies, whose mothers took anti-epileptic drugs (AEDs) during pregnancy, did not suffer any major birth defects1. The data from the UK Epilepsy and Pregnancy Register recently published in the Journal of Neurology, Neurosurgery, and Psychiatry Online, did show however differences in risk between the AEDs in common usage in the UK.

"Up until now, we've been unable to know the exact size and nature of the risk AEDs pose to the unborn child. These results are significant as they reveal that AEDs carry a small risk for pregnant women. However this is just a start. We need more pregnant women with epilepsy to join the register, so we can both test these results and continue to monitor the increasing range of drug treatments available", said Dr Jim Morrow, consultant neurologist at the Royal Victoria Hospital, Belfast, and national co-ordinator of the Pregnancy Register.

Epilepsy is the most frequent serious neurological condition affecting one in every 131 people in the UK1,2, and often requires life-long treatment with AEDs to prevent seizures. Women with epilepsy may be at higher risk of pregnancy and labour complications than women without epilepsy and the potential effect of AEDs on the unborn child raises additional concern. With an estimated three to four pregnancies in every thousand occurring to women with active epilepsy,3,4 there are up to 2,400 babies at potential risk every year.

"This new piece of research is very important because it defines, more clearly than previously, the risks to the unborn child associated with different AEDs taken during pregnancy," says Philip Lee, Chief Executive of Epilepsy Action. "The study will assist the clinician in providing more specific pre-conceptual counselling for women with epilepsy and help clinicians work with women to choose the most appropriate AED regime for them. The best regime for an individual woman will aim to achieve good seizure control for her and pose the minimum risk to her unborn child".

The UK Epilepsy and Pregnancy Register is a prospective, observational registration and follow-up study, established in 1996, to assess the risk to women with epilepsy and their babies. Neurologists, epilepsy nurse specialists, obstetricians, midwives, general practitioners and other care professionals caring for women with epilepsy refer cases to the register. Women can register themselves directly via the free phone number or the website.

Cases suitable for inclusion are pregnant women with epilepsy, whether or not they are taking an AED in any combination and who are referred to the register before the outcome of the pregnancy is known. By March 2005, 4,414 pregnancies had been registered, of which 3,607 had full outcome data. The aim of the register is to identify the risk and type of major congenital malformations (MCMs) seen with each drug and the relative risks between AEDs. The presence of MCMs recorded within the first three months of new-born life is the main outcome measure.

Following a nationwide art competition, the UK Epilepsy and Pregnancy Register has launched a new visual identity. Entrants were asked to reflect the purpose of the register in their designs and incorporate the themes of epilepsy and pregnancy. A large number of exciting entries from all age groups were received from across the UK. The winning entry will be used to represent the register going forward.

About the study

The full copy of the study can be found by visiting: jnnp.bmjjournals.com/cgi/rapidpdf/jnnp.2005.074203v1

The study is due for publication in the print version of Journal of Neurology, Neurosurgery, and Psychiatry in 2006.

For more information on the UK Epilepsy and Pregnancy Register, please call freephone 0800 389 1248, or visit http:// epilepsyandpregnancy.co.uk

About Epilepsy Action

Epilepsy Action is the UK's largest member-led epilepsy organisation, with around 18,000 members. As well as campaigning to improve epilepsy services and raise awareness of the condition, we offer assistance to local people in a number of ways including a national network of branches, accredited volunteers, regular regional conferences and a Freephone Epilepsy Helpline (0808 800 5050).

For more information, visit http://www.epilepsy.org.uk

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