58,59 Over the last decade LTG was established as the major medication in women with see more epilepsy who plan pregnancies, due to its favorable safety profile, which will be discussed in a later section. If one considers this development, it is surprising that it took several years until a Danish group discovered the pronounced and clinically relevant influence of oral hormonal contraceptives on LTG60 This was soon confirmed by other studies.61-64 It has been claimed

that ethinyl estradiol, but not progestérones, are responsible for this reduction of the LTG serum concentration.65 In women on hormonal contraception Inhibitors,research,lifescience,medical and LTG it is therefore reasonable to intensify therapeutic drug monitoring and either to increase the overall dosage to overcome seizure relapses during the fall of the LTG serum concentration or to consider a continuous Inhibitors,research,lifescience,medical hormonal contraception without a placebo interval. Other methods of hormonal contraception It has been suggested that the intramuscular application of sex steroids that bypasses the hepatic first-pass metabolism may be a way to achieve a higher contraceptive safety in patients on enzyme-inducing AEDs. However, the data on this issue are controversial, and not

Inhibitors,research,lifescience,medical sufficient. It was shown that the efficacy of levonorgestrel is reduced.66,67 Data on medroxyprogesterone are not yet available.68 For safety reasons it was suggested that, the injection interval should be shortened from 12 to 10 weeks.54 Whether or not this is really effective is not absolutely sure.25 Pregnancy – the mother’s side The course of epilepsy during pregnancy There are no reliable predictors of the course of epilepsy Inhibitors,research,lifescience,medical during pregnancy.55 It has been reported that the

risk of seizure relapses corresponds to the seizure type, since an increase in seizure frequency was significantly more often found in patients with complex partial seizures than in cases with generalized tonic-clonic and absence seizures.69 However, this series of 79 pregnancies is certainly too small to draw reliable conclusions. Similarly, the observation Inhibitors,research,lifescience,medical that a high seizure frequency prior to the pregnancy or the duration of the disease correlate with a higher risk of increased seizure frequencies during pregnancy,70 result from statistically unconvincing sample and sizes, and have been questioned somewhat.71 Several prospective pregnancy registries are being maintained in order to generate more reliable data on the course of pregnancy in patients with epilepsy and on the impact of AEDs in epileptic and in nonepileptic women. In most instances the course of epilepsy does not change during pregnancy. According to several previously published surveys, the seizure frequency remains stable in 50% to 85% of pregnancies of epileptic women. 16,24,49,71,72 The assessment of 1956 pregnancies in 1882 patients revealed that 58.3% remained seizure-free throughout the whole period of pregnancy.