At a glance
- Discuss pregnancy plans with your neurologist before conception.
- Transition from paediatric to adult care needs a planned handover.
- Coexisting conditions and medicine interactions are particularly important in older people.
Age, sex, other conditions, medicines and life plans can all influence epilepsy assessment and treatment.
Planning a pregnancy
Discuss pregnancy before conception where possible: review seizure control, medicines and doses, potential risks to the baby, and care during pregnancy and after birth.
Do not stop antiseizure medicines yourself after a positive pregnancy test. Uncontrolled seizures can also pose risks to both mother and baby. Contact your treating doctor promptly.
Transition to adult care
Between the ages of 16 and 18, the transition from paediatric to adult neurology can put important information at risk of being lost: early seizure history, EEG, imaging and genetic results, previous medicines and reasons for changes.
This is a useful time to revisit the cause of epilepsy, including a possible genetic cause, particularly if it started in early childhood and remains unexplained, or if developmental difficulties, intellectual disability or autism coexist. Identifying the cause may clarify prognosis, inform family counselling and sometimes guide treatment.
Driving, education and career choices, contraception, sleep and alcohol should also be discussed.
The practice sees patients aged 16 and over. For patients under 18, consent is required from the patient and their legal representative. Younger children should be assessed and treated by a paediatric neurologist.
Older adults
A first seizure can occur in later life. Assessment considers cerebrovascular and other structural brain conditions, as well as fainting, metabolic disturbances and medicine effects. Coexisting conditions, interactions and careful dosing are especially important.
More than seizures
Epilepsy can affect memory, concentration, mood, sleep, education, work and relationships. Care may include neuropsychological assessment, psychological or psychiatric support and, as needed, collaboration with a gynaecologist, cardiologist, geneticist, neuroradiologist or neurosurgeon. The aim is both fewer seizures and the best possible daily functioning.
What to bring
- Pregnancy planning: your medicines and doses, and information about contraception.
- Transition: a paediatric neurology summary, EEG, MRI and genetic results, and previous medicines.
- Older adults: all medicines, including over-the-counter products, and records of other conditions.
Michalina Malec-Litwinowicz, MD, PhD
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