Safe Anti-Seizure Medications for Pregnancy

A recent study from Stanford Medicine has provided new insights into the safety of two commonly used anti-seizure medications, lamotrigine and levetiracetam, during pregnancy. Published in JAMA Neurology, the study offers valuable information for healthcare professionals managing epilepsy in pregnant women. This research is the first to assess the long-term effects of these drugs on children born to mothers who took them during pregnancy. It confirms that these medications are safer alternatives to older, riskier drugs like valproate, which is associated with developmental and cognitive risks in children.

The study’s key finding is that children whose mothers took lamotrigine or levetiracetam during pregnancy had normal verbal abilities at age 6, similar to children of healthy mothers. These findings were consistent across a range of cognitive and psychosocial measures, with no significant differences observed. According to Dr. Kimford Meador, lead author and professor of neurology, the results are encouraging for both physicians and patients, offering a safe medication option for pregnant women with epilepsy.

Historically, women with epilepsy faced significant medical and societal challenges, including being discouraged or even prevented from having children. As Dr. Meador notes, this reflects a troubled past rooted in ignorance, but the advancements in epilepsy care and anti-seizure medications today represent a positive shift toward better outcomes for mothers and children alike.

However, managing epilepsy during pregnancy remains challenging. Seizures can be harmful to both the mother and fetus, so controlling them is crucial. That said, pregnant women’s bodies change rapidly, which can impact the effectiveness of anti-seizure drugs. Pregnancy speeds up metabolism, reducing the concentration of medications like lamotrigine and levetiracetam, requiring careful monitoring of drug levels and dosage adjustments to maintain control over seizures.

The study monitored 298 children born to women with epilepsy and 89 children from healthy women. It focused on verbal abilities at age 6, taking into account various factors like maternal IQ and education. Interestingly, the research also found that higher doses of lamotrigine during pregnancy appeared to have a slight positive effect on verbal ability, though excessive doses were not recommended. On the other hand, higher doses of levetiracetam were associated with a decline in verbal performance, though further studies are needed to confirm these findings.

Importantly, the study also highlighted the potential risks of acetaminophen, commonly used for pain relief during pregnancy, linking it to impaired neurodevelopmental outcomes. However, it also reinforced the benefits of folic acid supplementation early in pregnancy, noting improvements in cognition and behavior at age 6 for children of women with epilepsy.

Looking ahead, the study calls for continued research to fully understand the effects of epilepsy drugs on developing brains, especially in identifying genetic factors that may predispose certain individuals to greater risks. Despite the progress made, Dr. Meador emphasizes the ongoing need for improved epilepsy care and better-informed decisions regarding anti-seizure medications for pregnant women.

More information: Meador, K. J., et al. (2024) Neuropsychological Outcomes in 6-Year-Old Children of Women With Epilepsy: A Prospective Nonrandomized Clinical Trial. JAMA Neurology. doi.org/10.1001/jamaneurol.2024.3982