I am going to my neurologist on Friday to discuss the current status of my seizure disorder and if I need to begin the process of changing medications in order to ensure a safe pregnancy. However, I DO NOT plan on being pregnant any time soon, if at all, so I'm hesitant to even change meds.
I currently take Depakote ER, 500 mg daily. I have only had 5 seizures, spanning from 2002 to 2004, all in the morning just after waking up. I am completely controlled on medication, and I have very few side effects from the drug. Needless to say, I'm content on staying on Depakote for the rest of my life.
However, I've done a lot of research, and it seems that my medication is one of the worst AEDs to be on if you're pregnant. During our last visit, my doctor hinted at switching my medication soon after I graduated college.
Basically, I'm scared. Does anyone have any advice? What is the best AED to be on if you're pregnant? Has anyone had a baby while taking Depakote, and if so, were there any birth or developmental defects? I also am afraid of switching meds for the sole fact that I may have breakthrough seizures, which could very well occur while I am driving to work in the morning. I do not want this transition to affect my life, but I am afraid that it definitely will. Any advice would be greatly appreciated!! Thank you
I've heard the safest med to be on while pregnant is Lamictal. They say Keppra is pretty safe, too, but they haven't collected enough data in the research of it yet to say for certain.
In regards to changing meds, I think they will probably start you on the new med before taking you off of the Depakote. That's what my doctor is doing. I had wanted to switch from Tegretol and Keppra to Lamictal for when I want to have kids someday. Plus, my meds weren't working as well as I wanted them to, and I'm on a really high dosage of them both. So I had a VEEG in July, and they saw how many seizures I was still having, and started me on Lamictal right in the hospital. I've been on it for a month and a half now, and have only had 2 tiny seizures that only lasted a few seconds, when before I was getting simple-partial seizures, sometimes multiple times a day, that would last at least a half hour. I have an appointment with my doctor in a couple of weeks to discuss weaning me off my other meds. I think since I'm already on the Lamictal, which is working well, the gradual subtracting of the other meds will be safer. I think this might be what they usually do when starting someone on a new med, just to make sure you're protected while the other meds are subtracted. I haven't been through the whole process, though, so I can't tell you my own experience any further than just the addition of the new med. But don't worry too much.
Hi there, Im currently on this process myself, Im seizure free post-surgery 16 months now. I already spoke to my neuro, but Im on Keppra and trileptal (a few yrs now), and Keppra IS NOT a good med to get pregnant on, it can cause brain and spinal disformalities on the fetus on the first weeks. This is why the neuro started me on Folic acid everyday first for a year, and although he first said I coud get pregnant now, the GYN advices to tamper off these strong meds first and clean the blood stream and not risk it. If your still having seizures and need meds, Tegretol is one used while on pregnancy, my friend (also a nurse) used it to have 4 healthy kids... That will depend on your neuro. Im hopeing to get pregnant latest next summer, so any other info by my neuro, Ill post it . Also keep me posted on your neuro's opinion, but go first and buy Folic Acid (400mcg) and take 1 a day to stregthen your uterous and cardiovascular, all women on AEMds should take this, is over the counter. Good luck
Last edited by 030free; 09-04-2008 at 09:28 AM.
Thank you both for your advice. I actually have been taking Folic Acid every day with my medicine since I started on it way bay in 2002. The only time I stopped taking it was for the 9 months that a doctor assumed he had "cured" me of my seizures (that's right.. he said "cured"), and took me off of my medicine to prove I was alright. It took 9 months (my senior year of high school), but then I had a seizure in June, so they put me back on the Depakote and I've been on it ever since June of 2004. I haven't had any seizures since then, and am completely controlled on my meds.
I have a whole list of questions I want to ask my neuro tomorrow, but from what I gather, Lamictal is the best drug for me to be on? What about Topomax? I've had migraines before and read that this drug can work for both epilepsy and migraines; maybe I can knock out two birds with one stone
Thanks for your advice though! I'll post what my neuro says after my appt tomorrow.
The fact is that none of these drugs is optimal for pregnancy. All of them double the chance of birth defects (to something like 4%, I think) and I'm pretty sure that breast feeding is contraindicated for them all too. I have been taking Folic Acid along with my Tegretol for about 10 years, because that addresses the spinal biffita (sp?) concern. My neuro thinks all women of child-bearing age should be taking a Folic Acid supplement and in the month I intend to start trying to get pregnant he recommends I up it from the 1 mg to 4 mg.
I recently switched off of Tegretol, to see if I can improve my energy, and onto Keppra. The short answer about Keppra is that no one really knows its effect on babies since it is relatively new. It is listed as a Category C drugs with regard to pregnancy by the FDA, which means that there is not enough info to draw a conclusion yet. Tegretol, and I believe Depakote too, are Category D drugs, meaning they know they can be harmful but that the therapeutic benefit outweighs the risk. Here's a link to the FDA's categorization system: [url]http://www.fda.gov/fdac/features/2001/301_preg.html#categories[/url].
There is another benefit to switching off older epilepsy drugs (like Tegretol) and on to newer ones (like Keppra): Long term studies have shown that the older epilepsy drugs have negative effects on bone health, creating an increased risk of osteoperosis. My neuro told me he was always intending to switch me off the Tegretol because of this risk, but was hesitant to do it at this point until I brought up the energy problems I was having because my seizures have been so well-controlled on it.
Pregnancy and meds has been an increasing concern of mine. I'd be really interested in anything that your neuro has to say on the issue. Mine has been very supportive of it, despite my medical condition, because having a seizure while pregnant would be so much more of a risk to a baby's health than is taking my prescription.
Lets hope the new meds help you, but it is more serious to get pregnant if your still having spells, so its more risky but not impossible. Many women have had children on AEMds and done well, but like you said there are so many more concerns then the pregnancy alone, future meds' side effects, baby problems, more spells, ect... That's why Im going to give my neuro more time while I study this further. Best of luck...
Last edited by 030free; 09-05-2008 at 09:40 AM.
Yes Sentencedoing, so I was told, but once again this would depend on your neuro, she was lucky but her pregnancies were years ago. Now Keppra although category C I was told its not safe due to all the high risks of birth deffects. Im also on Trileptal high doses, so my neuro's concern its not so much the seizures since I been free so far, but the combination of 2 AEMds and the health risk for the fetus. Im still doing lots of research, and talking to my docs, neuro, and GYN. I want to get off these meds in a few months and then plan the pregnancy then, but only time will tell.
Several years ago, my neuro told me that if I became pregnant he'd switch me to Lamictal (I take Tegretol). I wasn't even thinking about pregnancy at that time, but he wanted to have a plan in place just in case. I was diagnosed and started on Tegretol when I was 19, so I was also immediately started on folic acid supplements, as well. I get a prescription, as I can get a higher dose in one pill and it's covered by insurance. Many AEDs can up the risk of neural tube defects, like spina bifida, and the folic acid can attempt to lower the risk a bit. Neural tube defects occur in the first 8 weeks of pregnancy, so it's important to be on folic acid before becoming pregnant.
Another poster mentioned bone issues and Tegretol- I was also told this and advised to take calcium and vitamin D to help prevent bone issues. I'm not so good at remembering those... I have to get better at that.
As far as Topamax (I think someone asked about this one)- I think it's a category C drug, not enough is known.
Chat with your doc.
I have been on Tegretol for most of my life often in combination with other meds. Your doc will assist better to change now before pregnant than be on an undesirable drug when it happens by surprise. I have a delightful 9 year old son and I was on meds throughout the pregnancy. Check also the viability of breastfeeding. I was very disappointed when I could not breastfeed. It would have been fine if I had been warned that that was the case.
I didn't find out I had epilepsy til 2006. I was put on lamictal right away. When I found out I was pregnant a year later I stopped my meds rite then. But my seizures were coming to strong. So I looked up the effects on the baby. Lamictal can cause the baby to have a cleft in it's mouth. I didn't want to take the meds but I falling down from a seizure could've killed my son. Well, I took my meds just a very low dose. I made sure my OB stayed in touch with my neuro Dr.. now I have a handsome 3yr old with a perfect smile.
Just make sure your doctors talk. There is nothing wrong with my son. He is tall, very active, he has no learning problems. He is just a normal 3yr old.......
Good luck with what you decide to do.
I had two healthy kids. my doctor just changed my med a little..you shouldn't have any problems...My doctors husband, also a neurologist suggested i terminate my pregnancy..good thing he wasn't my dr...
I gave birth a year ago to a healthy baby girl while taking keppra 1500bid. I took my multivitamins and folic acid, and just consumed an overly healthy diet of fruit and whole grains. keppra is category C, but she came out perfect. I am pregnant with baby number 2 and so far so good. My labor was complication free. best wishes