74 Electroencephalography (EEG) in women with epilepsy prior to and BLZ945 during pregnancy did not reveal any increase in epileptiform discharges.75 Increases in the seizure frequency appear in approximately 20% to 35%, and decreases in 3% to 22% .71 Data from the EURAP study registry, which are prospectively collected, suggest increases in seizures in 17.3% and decreases in 15.9%. 73 These rates are almost identical with data from Norway that report. 17% and 15%, respectively.74 Status epilepticus is a rare complication; it is thought to occur in less than 1% of pregnancies.24 More recent, data collected in almost 2000 pregnancies suggest an even lower rate (36 cases =0.02%).73 The latter study reported one stillbirth as the only

Inhibitors,research,lifescience,medical complication, and therefore indicated a lower risk for mother and child than previously reported (mortality rates of 31% for the mother and of 48% of the child,24 tenfold

increased mortality in women with epilepsy during pregnancy76) Inhibitors,research,lifescience,medical which has since been confirmed by others.74 Seizures were observed in 2.7% and 3.5%, respectively, during delivery.73,74 In the Norwegian study status epilepticus occurred in Inhibitors,research,lifescience,medical 1 % with delivery.74 The seizure risk is elevated ninefold on the delivery day; seizure rates reached almost. 20% in one study.77 Others report that seizures occur in 1% to 2% of patients during the 24 perinatal hours.78,79 According to Bauer,24 precipitating factors are: 1 . Patients forget Inhibitors,research,lifescience,medical to continue their oral AED medication. 2. Sleep deprivation around the delivery, especially in patients with idiopathic generalized epilepsies. 3. Intermittent, hyperventilation, again especially in patients with idiopathic generalized epilepsies. 4. The psychological stress during delivery. An increase in seizures during the whole pregnancy period is explained by various factors such as lack of compliance because of fear of teratogenic AED effects, increased levels of the theoretically preconvulsive estrogens, Inhibitors,research,lifescience,medical modified gastric motility, and an increase in nausea and vomiting.80 One other factor could

be the influence of the metabolic changes during pregnancy on the pharmacokinetics of AEDs. Modified pharmacokinetics of AEDs may result from altered protein binding or increased hepatic metabolism.80 Among the new AEDs, too LTG has been advocated as a first-line drug due to its promising teratogenic profile81,82,83; this will be discussed in detail later in this article. Since therefore numerous patients are treated with LTG during pregnancy, it is clinically relevant to know that LTG serum levels drop during pregnancy due to a large increase in clearance, above 65%, and which may exceed 300%. 62-73-84-85 This was explained by the increased metabolism of LTG.85 Accordingly, seizure relapses under LTG monotherapy during pregnancy and the necessity to increase the dosage were observed.62,73,84,85 Similarly, OXC had to be increased during pregnancy due to seizure relapses.