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Disclaimer is Guideline attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. is Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. e ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aer consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. 106 Commerce Street, Suite 105 Lake Mary, FL 32746 TEL: 407.878.7606 • FAX: 407.878.7611 For additional copies: info@GuidelineCentral.com Copyright © 2012 All rights reserved Abbreviations AAN, American Academy of Neurology; AED, antiepileptic drug; CBZ, carbamazepine; ESM, ethosuximide; GBP, gabapentin; LTG, lamotrigine; LVT, levetiracetam; MHD, monohydroxy derivative; MCM, major congenital malformation; OXC, oxcarbazepine; PB, phenobarbital; PHT, phenytoin; PRM, primidone; SGA, small for gestational age; TPM, topiramate; VPA, valproate; WWE, women with epilepsy Source Reports of the Quality Standards Subcommittee and erapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society: 1. Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy- -focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency. Neurology. 2009 Jul 14;73(2):126-32. Epub 2009 Apr 27. 2. Harden CL, Meador KJ, Pennell PB, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes. Neurology. 2009 Jul 14;73(2):133-41. Epub 2009 Apr 27. 3.Harden CL, Pennell PB, Koppel BS, et al. Practice parameter update: management issues for women with epilepsy- -focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding. Neurology. 2009 Jul 14;73(2):142-9. Epub 2009 Apr 27. Clinical context and AAN Disclosure omitted. See published guidelines for complete text. Preconception and 1 st Trimester Folic acid (C) Stop smoking (C) Optimize Rx Avoid VPA (A) Favor CBZ (A), PHT (C), and LTG (C) over VPA (MCM risk) Avoid AED polytherapy (B) Consider monitoring : LTG, CBZ, PHT (B); LVT and OXC (C) PRM and LVT (B) GBP, LTG, and TPM (C) transfer into breast milk more than VPA, PB, PHT, and CBZ During Breastfeeding Epilepsy in Pregnancy During Pregnancy