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Is it safe to plan for pregnancy while on treatment for seizure?

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Posted on Wed, 8 Jun 2016
Question: Hello DR, I am 29 ys old now. I am trying to conceive.In past I had faced 2 miscarriages.Also as I am a neuro patient
I am having anti epileptic drugs since last 3.5 years

First time I hd miscarraige the baby was 5.5 month old, so it was like normal delivery,during that period I was having
oleptal OD 600 tablet twice a day( so 1200 mg per day) , As I also had seizure one time when i was pregnant, my neuro doctor
gave me Frisium tablet 10 mg from 4th month onwards, and I was asked to continue with that till miscarriage took place.

Also most importantly this miscarriage was due to Rubella infection,so doctors adviced me not to take a riskso I was forced
to voluntarily terminate the baby though it was a very painful decision for me and my husband.

Second time I had miscarriage during my 3rd month of pregnancy due to enexpected bleeding.
At thiis time I was having oleptal OD tablet 900*2 mg(1800 mg per day)
I am not sure due to what reason this miscarriage was, but it was really shocking for me.So I went for DNC in month of Sep 2015.

The last time I had a seizure was in month of Feb 2016 once, before that Dec 2015 once.
I face this seizure for around 20 seconds, if I describe more on that, I can very wel handle myself during that 20 sec
as I know whr I am currently and what I am doing but I cannot concentrate on the work I am doing.

To give you backgrond,I did my BE and currently working.

As the seizures could not be stoped completely with oleptal, my DR, suggested Keppra tablet,so the process of increasing Keppra
and slowlyy decreasing oleptal is currently going on.Keppra was started from XXXXXXX 2016.After starting keppra I faces minor seizure
once in Feb.
Now my current dosage is oleptal od 600 * 2 (1200 md per day) and Keppra 500 mg in morning and 750 in night(1250 per day)

My doctors idea is to slowly decrease oleptal slowly, if i dont get seizures atleast for 2 months.

As per my knowledge from pregnancy point of view, I believe Keppra is better than oleptal.

With my current dosage can I start planning for baby now? This is my greatest concern.
Aso in next 2 weeks I am expecting my DR to reduce oleptal to 900 mg per day, as I did nt get any seizures since last 1.5 month.

Since last 6 month I have been postponing my pregnancy plan just control seizures and neuro tablets, before I go for baby.
Now I am already 29 rs old, Please advice me as I am not much interrested in postponing my pregnancy plan more and more.
doctor
Answered by Dr. Neeraj Kumar (2 hours later)
Brief Answer:
Wait for few more months to shift to single antiepileptics

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Seizures in pregnancy or issues of conception on drugs are to be treated under neurologist.
The best situation is to go for pregnancy with one anti epileptic and at minimal possible dose.
Combination of drugs and higher dosage lead to increased risk of malformations.
Best option will be to delay pregnancy for few months until oleptal is stopped and you are on a single drug keppra with seizure control.
Other option can be to conceive and be in regular ultrasound monitoring for any congenital birth defects. This is not advised and supported by me personally as any detection of malformations may lead to another abortion with bad effects on your mental health.
Folic acid supplementation is to be taken before planning for conception ( 3 months before conception to 12 weeks pregnancy)
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Neeraj Kumar (27 hours later)
Hello DR,

Thank you very much for you clear feedback.
I have been having folol 5mg tablet in morning and evening.
Is there any other folic acid tablet suggested specially for patients like me?

I have few more concerns :-

1) To be on safer side, as a limit,how much of mg maximum can be consumed in case of Keppra before I start planning for baby.( After oleptal is stoped completely)

2) If I am forced to take oleptal and Kepra together, maximum of how much dosage of oleptal and Keppra can be taken together.(currently I am haing 1200 mg of oleptal and 1250 mg per day).I belive this is too high.

3)In case I dont get any seizures for next 4 to 5 months, can oleptal be stopped completely?
Can this be reduced month on month or once in 2 months by 300 mg.

4)Please give me some useful points that I need to follow strictly to avoid seizures?
Is there anything on eatables, that wil help me avoiding seizures,or something that I need to avoid eating.
I have met many Neuro doctors in past, but dont get much feedback on food that is advicable.

5) Also my gynac DR has suggested to me to take Neurobion injection once in 10 days. WIll that really help me or needed?

6) As mentioned in my yesterdays question, my first miscarriage was due infection Rubella, I was forced to voluntarily take that step.

Just to highlight, in those 5 months when I was pregnant, I did not face any fever, or even other minor issues, so this Rubella was due to Neuro tablets or anything related to Neuro?
Also at that time in my 4th month I also had frisium tablet, so I believe that would have been cause. Can that be the reason?

7) Any other precaution that I need to take as I wil be planning fo baby in neaar future.

Please give me your suggestions for my above mentioned concerns.


Thank you very much for your answers, as I am really taking your answers into account and this will help in taking major decisions in my life.

Thank you

In general I feel very confident, as a very normal person like others,it gets dificult for me to believe that I get seizures.even thought seizures are very minute,and controllable.

doctor
Answered by Dr. Neeraj Kumar (16 hours later)
Brief Answer:
Take steps and precautions as advised in detail

Detailed Answer:
Hello XXXX,
I am answering all your concerns one by one.
++ Any folic acid of dosage 5 mg per day is sufficient. Some studies have shown more benefit of higher doses as being given to you. So continue the medication as prescribed.
Query 1) To be on safer side, as a limit,how much of mg maximum can be consumed in case of Keppra before I start planning for baby.( After oleptal is stoped completely)
Answer 1) Keppra is a relatively safe drug and can be continued at doses prescribed presently. However if possible doses should be decreased to 1000 mg per day.


2) If I am forced to take oleptal and Kepra together, maximum of how much dosage of oleptal and Keppra can be taken together.(currently I am haing 1200 mg of oleptal and 1250 mg per day).I belive this is too high.
Answer) The intake of both drugs is associated with 3-4 times higher risk of congenital malformation in fetus as compared to keppra alone and thus should be tried to shift to a single drug.
If not possible then keppra less than 1000 and oleptal less than 600 should be targeted. Its all relative and no dose is absolutely safe. Constant monitoring under guidance of a gynaecologist is advised.

3)In case I dont get any seizures for next 4 to 5 months, can oleptal be stopped completely?

Can this be reduced month on month or once in 2 months by 300 mg.
Reply3) olpetal should be gradually decreased in monthly schedule to stop in next 6 months.


4)Please give me some useful points that I need to follow strictly to avoid seizures?

Is there anything on eatables, that wil help me avoiding seizures,or something that I need to avoid eating.

I have met many Neuro doctors in past, but dont get much feedback on food that is advicable.
Reply 4 : It is important to have adequate rest, proper night's sleep and timely drug avoid seizure. Food directly doesn't has an effect on seizure and diet needed during pregnancy should be taken.



5) Also my gynac DR has suggested to me to take Neurobion injection once in 10 days. WIll that really help me or needed?
Reply Not required



6) As mentioned in my yesterdays question, my first miscarriage was due infection Rubella, I was forced to voluntarily take that step.
Reply : This condition is not related to drug. However the rubella reports should be discussed with your gynaecologist.

7) Any other precaution that I need to take as I will be planning for baby in the near future.
Reply : Above mentioned precautions and advice will be helpful.
Wishing you good health.
Regards
Dr N Kumar
neurologist
Above answer was peer-reviewed by : Dr. Deepak
doctor
Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2263 Questions

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Is it safe to plan for pregnancy while on treatment for seizure?

Brief Answer: Wait for few more months to shift to single antiepileptics Detailed Answer: Hello, I have gone through your question and understand your concerns. Seizures in pregnancy or issues of conception on drugs are to be treated under neurologist. The best situation is to go for pregnancy with one anti epileptic and at minimal possible dose. Combination of drugs and higher dosage lead to increased risk of malformations. Best option will be to delay pregnancy for few months until oleptal is stopped and you are on a single drug keppra with seizure control. Other option can be to conceive and be in regular ultrasound monitoring for any congenital birth defects. This is not advised and supported by me personally as any detection of malformations may lead to another abortion with bad effects on your mental health. Folic acid supplementation is to be taken before planning for conception ( 3 months before conception to 12 weeks pregnancy) Hope you found the answer helpful. Do get back to me for further queries. Regards Dr N Kumar Neurologist