grandstand. Epilepsy and pregnancy: Maternity is possible under medical supervision

Epilepsy complicates a woman’s reproductive life. However, improved diagnosis and treatment of this disease, as well as better social adjustment, have made it possible for most women with epilepsy to marry and have children.

Collaboration between the neurologist and the obstetrician is important to optimize the management of women with epilepsy who are trying to have children. And by planning pregnancy and selecting appropriate prior treatment to respond to the twin challenges of maintaining seizure control while minimizing the risk of developing a teratogenic malformation, women with epilepsy can become mothers.

Compared to pregnant women without epilepsy, pregnant women with epilepsy have a higher mortality rate, a two to three times higher incidence (number of new cases) of preterm birth and other maternal and fetal complications.

Several complications may arise during treatment that require close monitoring. Because antiepileptic drugs are likely to cause malformative teratogenic effects in particular.

In order to avoid or minimize these complications, women with epilepsy must be accompanied from puberty onwards.

Collaboration between the neurologist and the obstetrician is important to optimize the management of these patients by planning the pregnancy and selecting the appropriate pre-pregnancy treatment to meet the twin challenges of maintaining seizure control while minimizing the teratogenic risk .

The choice of breastfeeding is individual, as there are no formal contraindications to breastfeeding in epileptic women undergoing treatment.

Compliance with these conditions inspires confidence and promotes a reassuring reproductive life for Moroccan women with epilepsy, concludes the scientific work led by Doctors M. Berrada, S. Ennigrou, S. Bellakhdar, B. El Moutawakil and MA. Rafai, published in the June 2022 issue of the Moroccan Journal of Practical Medicine.

It should always be remembered that pregnancy and childbirth are precious moments in a woman’s life. However, they can be responsible for physiological changes that can play a role in favoring the onset or aggravation of certain neurological pathologies, such as the epilepsy mentioned above or other more or less serious ones.

Thus, in a pregnancy that causes blood clotting to accelerate, there is a risk of occurrence of cerebral vein thrombosis.

Cerebral vein thrombosis corresponds to a localized or diffuse blockage of the cerebral veins by a blood clot. This can be the cause of cerebral edema, which can cause ischemia, namely the reduction or even cessation of blood supply to the brain.

Headaches are also a common complaint during pregnancy, with an estimated prevalence (ie number of cases of a disease in a population at any given time) of 35%.

The most common form of headache is migraine, which occurs primarily in the first trimester and after childbirth (postpartum).

Other potentially serious pathologies can be triggered during pregnancy and therefore it is necessary to seek and diagnose them to ensure proper treatment. Because some can affect the vital prognosis of the future mother through their complications.

A relatively common pathology in women of reproductive age is multiple sclerosis, whose flare-ups occur mainly in the first three months after birth and whose therapeutic implications are not always easy to manage by specialized medical teams.

Multiple sclerosis (MS), a neurological disease, is most commonly diagnosed between the ages of 20 and 40. More than two-thirds of MS patients are women. They are young and of childbearing age. And the influence of pregnancy on the evolutionary course of multiple sclerosis is controversial. Women with MS have long been discouraged from having children, arguing that the disease gets worse during pregnancy, but especially soon after birth. This is no longer the case today.

In another scientific study coordinated by the teams of the Department of Neurology of the CHU Ibn Rochd of Casablanca, the Laboratory of Genetics and Molecular Pathology of the Faculty of Medicine of Casablanca and the Research Laboratory of Diseases of the Nervous System, Neurosensory and Disabilities of the same faculty, also published in the June 2022 issue of the Revue Pratique de Médecine, pregnancy in multiple sclerosis is not contraindicated but must be programmed with a date of confinement.

And there are well-defined therapeutic protocols to carry the pregnancy to term and ensure delivery under optimal conditions.

The coordinators of this medical education file on pregnancy and neurological diseases, Dr. Malika Berrada and Pr. Mohammed Abdoh Rafai, reiterate that the various neurological disorders detected or triggered by pregnancy require close collaboration between neurologists, general practitioners, pediatricians and other specific situations, the anesthetist-resuscitator, for the individual care of each patients.

*dr Anwar Cherkaoui is a doctor. A winner of the higher cycle of Iscae, he was Head of Medical Communications at the CHU Ibn Sina in Rabat for thirty years.

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