Managing Epilepsy During Pregnancy

UNM Neurologist Launches New Clinic

Epilepsy, a neurological disorder that affects about 5 million people in the U.S., can be disabling if left untreated - and it poses special complications for pregnant women.

That's why Annapoorna Bhat, MD, an assistant professor in the UNM Department of Neurology, has launched a monthly clinic to help expectant mothers manage their epilepsy symptoms and deliver healthy babies.

"When I came here, our waiting period was several months to see an epileptologist," says Bhat, who joined the UNM faculty in 2017. That clearly didn't work for pregnant women. "I thought, 'There is a need for this special clinic where we can help them.'"

Epilepsy is a brain condition in which a person has unprovoked seizures, Bhat says. There are different types of seizures, including convulsive seizures and conditions in which someone might lose awareness without completely losing consciousness.

Focal seizures, which originate in a specific area of the brain, may result from a stroke, a tumor or a developmental abnormality. Generalized seizures, which ripple across the brain, are genetically inherited. "It's hard to predict how it will be passed on," Bhat says.

Seizures are often triggered by insufficient sleep or stress, she says. Drugs and alcohol may play a role, and for some they are triggered by external stimuli, such as flashing lights.

Neurologists have a number of drugs available that can prevent the recurrence of epilepsy symptoms - and the newer ones are safe for use by pregnant women, Bhat said. Epilepsy patients typically see their specialist every three to four months, but her clinic ensures that mothers-to-be are seen every month during their pregnancy.

"The biggest thing in epilepsy is getting to the right medication and putting them on the right dose," Bhat says. Doctors prefer to use the minimum dose needed to get a response, but she notes that in pregnancy women gain weight and retain fluid, so higher dosages may be needed to be effective.

Three to five out of every 1,000 births in the U.S. are to women who have epilepsy, Bhat says, and about half a million of the people living with epilepsy are of reproductive age. When she sees an at-risk patient, "They always ask, 'Can I get pregnant?'" Bhat says. "The answer is always yes, with some counseling and precautions."

The goal is to get the seizures under control, because that is the best predictor of how they'll do during pregnancy," Bhat says, adding that if patients are seizure-free with the help of medication, they will likely stay that way during pregnancy. "They have to tell me at least one year before they try to get pregnant, so I can get them on the right medication, the right doses and the right follow-up plan."

Bhat says she enjoys her work, "Because there are a lot of options for patients that we can offer." In addition to medication, other treatments include surgery, special diets and implantable brain stimulators. And when a person's epilepsy symptoms are properly managed, she says, "It really makes a change in their life."