LETTER RE: How do you treat epilepsy in pregnancy?
Khichar PurnaramShubhakaran, MB, BS, MD(Med), DM Neurology, Physician, Dr. S. N. Medical College
Submitted August 25, 2017
I read the article by Dr. George with interest. [1] Eminent expert Dr. Charway-Felli (Ghana) touched on sensitive issues about affordability of newer drugs, Ghana's national health insurance scheme (which covers basic drugs like phenytoin, carbamazepine, and valproate), lack of drug availability at pharmacies, and an uncovered population in need.
The situation in India is likewise alarming, in spite of government-sponsored free and supportive services for 52% of females in the reproductive age group as compared to 25-40% mentioned in another recent article. [2] Valproate, lamotrigine, phenytoin, and carbamazipine are the commonly used drugs. [3,4]
We want to provide pre-pregnancy counseling, folic acid supplementation, optimal use of safer drugs like levetiracetam and lamotrigine, and blood level monitoring, but these services and drugs are not reliably available in India. The result may be seizures and other morbidities in pregnant women with epilepsy and their fetuses. Despite national health insurance coverage, premature births with congenital anomalies and mortality of mothers and newborns persist. It is time to confront poor outcomes in these especially vulnerable populations.
Disclosure: The author reports no disclosures.
References
1. George IC. How do you treat epilepsy in pregnancy? Neurol Clin Pract 2017;7:363-371.
2. Kinney MO, Craig JJ. Pregnancy and epilepsy; meeting the challenges over the last 25 years: the rise of the pregnancy registries. Seizure 2016;44:162-168.
3. Thomas SV. Managing epilepsy in pregnancy. Neurol India 2011;59:59-65.
4. Sahota P, Prabhakar S, Kharbanda PS, et al. Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: A cross-sectional study. Epilepsia 2008;49:2069-2077.
I read the article by Dr. George with interest. [1] Eminent expert Dr. Charway-Felli (Ghana) touched on sensitive issues about affordability of newer drugs, Ghana's national health insurance scheme (which covers basic drugs like phenytoin, carbamazepine, and valproate), lack of drug availability at pharmacies, and an uncovered population in need.
The situation in India is likewise alarming, in spite of government-sponsored free and supportive services for 52% of females in the reproductive age group as compared to 25-40% mentioned in another recent article. [2] Valproate, lamotrigine, phenytoin, and carbamazipine are the commonly used drugs. [3,4]
We want to provide pre-pregnancy counseling, folic acid supplementation, optimal use of safer drugs like levetiracetam and lamotrigine, and blood level monitoring, but these services and drugs are not reliably available in India. The result may be seizures and other morbidities in pregnant women with epilepsy and their fetuses. Despite national health insurance coverage, premature births with congenital anomalies and mortality of mothers and newborns persist. It is time to confront poor outcomes in these especially vulnerable populations.
Disclosure: The author reports no disclosures.
References
1. George IC. How do you treat epilepsy in pregnancy? Neurol Clin Pract 2017;7:363-371.
2. Kinney MO, Craig JJ. Pregnancy and epilepsy; meeting the challenges over the last 25 years: the rise of the pregnancy registries. Seizure 2016;44:162-168.
3. Thomas SV. Managing epilepsy in pregnancy. Neurol India 2011;59:59-65.
4. Sahota P, Prabhakar S, Kharbanda PS, et al. Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: A cross-sectional study. Epilepsia 2008;49:2069-2077.