"What’s New on Epilepsy.com Professionals in May?"

Over the past few weeks, there has been a considerable amount of media attention devoted to the field of epilepsy. A major cover story on epilepsy by Newsweek magazine on April 11, 2009 was followed by the publication of a major study in the New England Journal of Medicine linking valproic acid use to lower IQ’s in children of mothers who had taken the agent for epilepsy during their pregnancy. This led to the admission of celebrities like Prince admitting to having suffered from childhood seizures. On May 1, new clinical guidelines were published in Neurology regarding epilepsy management during pregnancy. These new guidelines which are jointly authored by the American Academy of Neurology and the American Epilepsy Society provide clinicians with several recommendations that can help decrease the risk of a complicated pregnancy. These recommendations also reaffirm that valproic acid should not be prescribed to women who are pregnant because it may cause fetal malformations and impair cognition in children of women who take the drug while pregnant.

The guidelines also go on to urge that whenever possible, women with epilepsy should not take more than one anti-epileptic drug at a time during pregnancy because it may increase the risk of birth defects. Pregnant women with epilepsy should have blood tests for anti-epileptic drug levels on a regular basis. Levels of anti-epileptic medications may decrease in the course of the pregnancy and regular testing will help detect when doses of the medication should be adjusted. If possible doctors should avoid prescribing phenytoin and phenobarbital to women of childbearing age with epilepsy in an effort to lower the chance of cognitive problems in children. Women of childbearing age taking these medications should always consult their physicians which should include their neurologist and obstetrician before making any changes to the medication regimen. The link to the clinical guidelines is below and we encourage all readers of the site to familiarize themselves with the paper.

Download the paper here. (PDF)

On a very different topic, May is also the unofficial beginning of the summer season. During summer, there is a marked increase in driving. After all, vacation season is upon us, children are out of school and there is desire to explore the outdoors. In the latter half of the month, we devote our Hallway Conversations to the issues of transportation and epilepsy. On May 6th, Dr. Allan Krumholz from the University of Maryland Medical Center, joins us on Hallway Conversations to discuss the issues of driving and epilepsy. On May 13th, Dr. Joseph Drazkowski in the Division of Epilepsy at Mayo Clinic Arizona, joins us to talk about how are driving laws evolving, what is research telling us and what are some of the suggestions in terms of helping people manage the issue of driving with their condition. Given that this is often an emotionally charged conversation with most patients, it is important to understand and grasp the fundamental issues that arise in this type of encounter. Lastly, on May 20th Jack Hastings, who is a consultant to the Federal Aviation Administration, joins us to discuss flying and epilepsy. What are the issues if a patient with seizures is about to embark on a journey involving a plane? What suggestions should we as physicians give our patients? and what if our patient wants to actually pilot a plane, what are the rules and how should we advise them?

Thus, as you can see we have a varied month of offerings in this month’s epilepsy.com/professionals. At the beginning of the month we concentrate on the issues of epilepsy and pregnancy with important new guidelines and research to support some of them. In the second half of the month the focus is on driving, flying and transportation. We hope that you find all of this helpful for your daily practice; we hope you join us for our hallway conversations, download our podcasts, read our materials and at the end hopefully improve the quality of life of all of our patients with epilepsy.

Sincerely,

Joseph I. Sirven, MD

Epilepsy.com Board members and contributors cannot give medical advice by email. Only a doctor who has examined the patient and reviewed the medical records can comment on individual patient issues.

We welcome suggestions for additional types of material, but we do not have the capacity to respond to individual requests for information.

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