This document provides guidance for prenatal care of women with epilepsy. It recommends taking folic acid prior to and during pregnancy to reduce risks. Women should be informed about risks of epilepsy, anti-seizure medications, and potential birth defects. Medications generally do not need changing if epilepsy is well-controlled, but converting to a single drug may be considered. Lower and monitored doses aim to prevent seizures while minimizing harm. Ultrasounds are suggested to monitor the fetus. Vitamin K supplementation is advised for women on certain anti-seizure medications. The newborn should also receive Vitamin K, and breastfeeding is encouraged. Risk of seizures increases around delivery, so safety precautions are important postpartum.

1. EPILEPSY
Prenatal advice
 History taking, proper exploration of her seizures.
 Advise to take folic acid 5mg daily prior to
conception, continue throughout pregnancy.
 Information about risk of epilepsy, anti- epileptic
drugs and their side effect, teratogenic risks.
 No need to change AED in pregnancy if epilepsy is
well controlled with phenytoin, carbamazepine,
valproate, lamotrigine or phenobarbitone.
 Withdrawal is inappropriate (those who have not
been seizure-free for two years, those whose specific
epilepsy syndrome is known to require continual drug
treatment and those unwilling to accept a risk of
seizure recurrence)
 Consideration should be given to converting multiple
drug regime to single drug regime.
 Lowest effective dose that protects against seizures.
 Offer nuchal translucency scanning and detailed
ultrasound at 18-20 week once she got pregnant.
ADMINISTRATION OF DRUGS
 Patients on hepatic enzyme inducing drugs should be
given Vitamin K 10 mg orally
 Neonate should receive 1 mg Vitamin K IM soon after
birth
DELIVERY AND POST NATAL CARE
- There is an increased risk of seizures around the time
of delivery and the following 24 hours
- Breast-feeding is safe and should be encouraged
- Mother should avoid excessive tiredness, changing
the baby on the floor to prevent fall, and bathing the
baby with another adult present in case of seizure.