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  |  General Health  |  Diseases and conditions  |  I want a baby but I'm epileptic
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I want a baby but I'm epileptic

by Dr Sarah Brewer

question
I want to start a family, but I have temporal lobe epilepsy and take carbamazepine (600mg) daily for this. What do I need to do before starting to try for a baby? I have been advised not to come off the anti-convulsant tablets, but have not been told of any alternative way of preventing spina bifida. I have tried numerous doctors, but all have been very vague. Please help – I have tried everywhere and can't get any answers.

answer
I think we have to say that virtually no drug is totally safe during pregnancy (and this includes nicotine and alcohol) and there is still a three per cent risk that abnormality of some sort can occur. Certainly, carbamazepine has been linked with some malformations when used during pregnancy, and these can include neural tube defects (like spina bifida).

Certain precautions are possible, and these will give improved circumstances. Usually a specialist is consulted before conception. The lowest possible dose of medication is discussed and then measured against actual symptoms, as the risks are reduced if the dose of the medication is lower rather than higher. A single anti-epileptic medication is organised if more than one type is being used before pregnancy.

Screening of the developing baby is offered early, and close observations made. Folic acid (5 mg daily) should be started before conception and continued for 12 weeks after. Medication is not usually withheld from a patient when it is used for control and management of major seizures, as the drug’s potential benefits must be weighed against the risks posed to both mother and baby.

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