III./4.7. Special issues related to epilepsy
Pregnancy
Teratogenic risk is increased in the first trimester (2-3% in healthy persons, 4-8 % in patients on AED treatment).
Generally, valproic acid is unfavorable in pregnant patients. Before conception, the dose of the drug should be lowered slowly
(sometimes it is possible even to temporarily stop the medication).
Pregnant patients on AED therapy should be advised to take 4 mg of folic acid per day. AED treatment should not be changed during pregnancy, unless seizure control worsens. Prenatal care is important (fetal ultrasound in Week 16 and 20, AFP serum level control).
Patients taking enzyme inductors should receive vitamin K supplementation in the third trimester.
Driving
The rules regarding driver’s license for patients with epilepsy are different in various countries.
Sudden Unexplained Death in Epilepsy (SUDEP)
It is well known that the mortality rate of epileptic patients is 2-3 times higher than in the general population. Sudden Unexplained Death in Epilepsy (SUDEP) occurs in 0.18% of patients with
epilepsy, and it is an important contributing factor to mortality. Severe epilepsy, young age, the presence of other neurological disorders, frequent seizures, and polytherapy all increase the risk of SUDEP.
There are several possible reasons explaining SUDEP (e.g. arrythmia, respiratory arrest or neurogenic pulmonary edema), but no anatomical or toxicological causes have been identified. Patients with epilepsy must be informed of the possible risk of SUDEP.
