Epilepsy in pregnancy (FOI)

​Request

A

How many pregnant women with Epilepsy (PWWE) are there currently in Jersey? Including pregnant and 1 year post-partum.

​B

How are ASM​'s (anti-seizure medications) monitored and moderated during the course of the pregnancy, and 1 year post-partum?

C

Which ASM's are typically prescribed to PWWE?

D

Are PWWE considered high risk and if so what special care pathway are they on compared to non-epileptic women?

Response

A

Fewer than five individuals with epilepsy are known to Health and Community Services to be currently pregnant or in the first 12 months post-partum. As numbers are small, disclosure control has been applied to protect individuals from identification, and Article 25 of the Freedom of Information (Jersey) Law 2011 has been applied to protect the privacy of individuals.

B to D

Given the changes in volume of distribution and the increased renal clearance and hepatic metabolism of antiseizure medications (ASMs) associated with pregnancy (see 'Increased antiseizure medication clearance' below), blood levels of ASMs should be followed at regular intervals. 

Free (unbound) drug levels for the highly protein-bound ASMs (for example, phenytoin, phenobarbital, valproate, carbamazepine) are more reliable during pregnancy. 

The optimal frequency of testing is unknown. The following testing regime is suggested, with adjustment of dosages as needed to maintain the patient's individualised target blood concentration:

• Routinely at four-week intervals throughout pregnancy, and beginning when pregnancy is reported
• Once at the six-week postpartum visit
• Immediately if the patient reports or presents with increased seizure activity or worsened seizure severity
• Immediately if the patient experiences dizziness, blurred vision, or other common complaints associated with ASM medication toxicity.

When ASM blood levels are not available, a 2019 report from the International League Against Epilepsy (ILAE) notes that it is reasonable to increase the ASM dose after the first trimester for women with epilepsy when the following conditions apply:

• The treatment involves ASMs that are prone to marked changes in clearance (lamotrigine, levetiracetam, and oxcarbazepine) with pregnancy
• The seizures include focal to bilateral or generalized tonic-clonic seizures
• The seizure control was sensitive to changes in ASM levels before pregnancy
• The patient entered pregnancy on the lowest effective ASM dose.

Pregnant women with epilepsy are considered high-risk. 

There is currently no special or alternative care pathway in use for pregnant women with epilepsy versus those without.

Monitoring of the epileptic condition is performed locally by the Neurology team.

Article applied

Article 25 - Personal information

(1) Information is absolutely exempt information if it constitutes personal data of which the applicant is the data subject as defined in the Data Protection (Jersey) Law 2018.

(2) Information is absolutely exempt information if –

(a) it constitutes personal data of which the applicant is not the data subject as defined in the Data Protection (Jersey) Law 2018; and

(b) its supply to a member of the public would contravene any of the data protection principles, as defined in that Law.​