2
Key Points
➤ Prioritize shared decision making with people with epilepsy of
childbearing potential (PWECP) to find the proper combination of
medications that optimize both seizure control and fetal outcomes before
pregnancy.
➤ Stopping antiseizure medications (ASMs) during pregnancy can increase
seizure frequency, which can harm both the patient and the child.
➤ Avoid valproic acid, phenobarbital, and topiramate (in that order) if
clinically feasible to minimize risk of major congenital malformations
(MCMs) and unfavorable perinatal and neurodevelopmental outcomes.
➤ Recommend folic acid supplementation for PWECP to decrease the risk
of neural tube defects, possibly decrease the risk of autism spectrum
disorder, and help improve IQ in their offspring.
Classification of Management Recommendations
Classification Definition
Level A
Denotes a practice recommendation that must be done. In almost
all circumstances, adherence to the recommendation will improve
health-related outcomes. Almost all patients in this circumstance
would desire that the recommendation be followed.
Level B
Indicates a recommendation that should be done. In most
circumstances, adherence to the recommendation will likely
improve health-related outcomes. Most patients in this
circumstance would want the recommendation to be followed.
Level C
Represents a recommendation that may be done. In some
circumstances, adherence to the recommendation might improve
health-related outcomes.
Level U
Indicates that the available evidence is insufficient to support or
refute the efficacy of an intervention.
Level R
Assigned when the balance of benefits and harms is unknown
and the intervention is known to be exorbitantly expensive or
have important risks. is level designates that the intervention
should not be used outside of a research setting.
