Step Down Treatment With Antieptileptic Drugs
The review article by Weil et al (1) is extremely useful because many pregnant women with epilepsy are still subject to restrictive treatment.
One aspect could even be articulated in a more apodictic fashion: under the aspect of “breast feeding,” the authors write “Mothers with epilepsy are not currently advised to desist from breastfeeding.” In my opinion,it should say: “Mothers with epilepsy should be urgently advised to breast feed!”
My reasoning: The fetus is in contact with all epileptic drugs that the mother is (hopefully meticulously) taking, via the umbilicial vein and amniotic fluid. The mean concentrations that are measured in the umbilical serum at the time of the birth are correspondingly high—relative to the concentration in the maternal serum—for example, cabarmazepine 66%, ethosuximide 104%, phenobarbital 96%, phenytoin 128%, primidone 100%, and valproate 133% (2).
Postnatally, the administration of antiepileptic drugs would be interrupted, with the subsequent risk of withdrawal symptoms, such as can develop for many entrally effective substances. By means of breast feeding and slow weaning, however, the baby’s intake of antiepileptic drugs is stepped down slowly over several weeks/months, since all antiepileptic drugs pass into breast milk: For example, carbamazepine 50%, ethosuximide 92%, phenobarbital 37%, phenytoin 50%, primidone 115%, and valproate 4% (relative to the mother’s serum concentration). The treatment administered to the neonates is thus stepped down, which is desirable.
Prof. Dr. med. Frank P. Meyer
Zur Magdeburger Str. 29
39164 Wanzleben-Börde, Germany
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
epilepsy. Dtsch Arztebl Int 2010; 107(45): 787–93.