Title : Individualisation of antiepileptic drugs and the role of levetiracetam in women with epilepsy
Active epilepsy among women of childbearing age is more prevalent compared to the general population worldwide. Women with epilepsy (WWE) face specific challenges related to hormonal function, and by extension, their sexual and reproductive health. The impact of epilepsy and antiepileptic drugs (AEDs) therapy in WWE at pre-conception include interference with the hypothalamic-pituitary-ovarian axis, fertility challenges, contraception failure, bone and thyroid health, as well as cosmetic side effects of treatment affecting adherence and quality of life. WWE also face elevated risks of teratogenicity AEDs, foetal loss, seizure precipitation, complications and mortality during pregnancy and labour. Impact of prenatal exposure of AEDs in children of WWE, such as birth defects, preterm birth and lower cognitive performance, are important considerations when selecting a particular AED therapy. The management of WWE requires attention to WWE-specific issues for individualisation of treatment. Tolerability and safety of AEDs are of paramount importance when differentiating between drugs. In this narrative literature review, we discuss the role of levetiracetam, alongside other AEDs in managing epilepsy in WWE at various stages of life: puberty, menstruation, pregnancy, and lactation. Treatment optimisation in WWE should be implemented early on, and should not be delayed until the discovery of pregnancy or development of adverse effects. Improved clinician awareness and patient education/counselling are essential to make informed decisions and mitigate risks.
Audience Take Away
- Understand the specific challenges faced by women with epilepsy
- Understand how these challenges may change throughout different life stages, from adolescence to pregnancy to postpartum stages
- An overview of levetiracetam in comparison with other ASMs in addressing clinical challenges faced when treating women with epilepsy