Epilepsy complicates a woman’s reproductive life. However, improved diagnosis and treatment of this disease, as well as better social adaptation, have enabled most women with epilepsy to marry and have children.
The collaboration between the neurologist and the obstetrician is important in order to optimize the management of women suffering from epilepsy who wish to become a mother. And it is by planning the pregnancy and selecting the appropriate treatment before it in order to respond to the double challenge of maintaining control of convulsive seizures while minimizing any risk of teratogenic malformation that women with epilepsy can become mothers.
Compared to pregnant women without epilepsy, pregnant women with epilepsy have a higher mortality rate, a two to three times higher incidence (number of new cases) of preterm birth and other maternal and fetal complications.
Several complications can be added during the treatment, which require rigorous monitoring. Because antiepileptics are likely to cause malformative teratogenic effects in particular.
To avoid or minimize these complications, women with epilepsy must be accompanied from puberty.
The collaboration between the neurologist and the obstetrician is important in order to optimize the management of these patients by planning the pregnancy and selecting the appropriate treatment before it in order to meet the double challenge of maintaining seizure control. seizures while minimizing the teratogenic risk.
The choice of breast-feeding is individual, as there are no formal contraindications to breast-feeding in epileptic women undergoing treatment.
Compliance with these conditions builds confidence and promotes a reassuring reproductive life for Moroccan women with epilepsy, concludes the scientific work supervised by doctors M. Berrada, S. Ennigrou, S. Bellakhdar, B. El Moutawakil and MA. Rafai, published in the June 2022 issue of the Moroccan journal of practical medicine.
It should always be remembered that pregnancy and childbirth are precious moments in a woman’s life. However, they may be responsible for physiological modifications which may play a role favoring the onset or aggravation of certain neurological pathologies, such as the epilepsy mentioned above or other more or less serious ones.
So, with pregnancy, causing an acceleration of blood clotting, there is the risk of the occurrence of cerebral venous thrombosis.
Cerebral venous thrombosis corresponds to an obstruction, localized or diffuse, of the veins of the brain, by a blood clot. This can be the cause of cerebral edema, which can cause ischemia, namely the reduction or even the cessation of the blood supply to the brain.
Headaches are also a frequent complaint during pregnancy, their prevalence (ie number of cases of a disease in a population at a given time) is estimated at 35%.
The most common form of headache is migraine, which occurs mainly during the first trimester and postpartum (after childbirth).
Other potentially serious pathologies can be triggered during pregnancy, and therefore it is necessary to seek them out, diagnose them, in order to ensure adequate management. Because, some can engage, by their complications, the vital prognosis of the future mother.
A relatively common pathology in women of childbearing age is multiple sclerosis, whose relapses mainly occur in the first three months after childbirth, and whose therapeutic implications are not always easy to handle by medical teams. specialized.
Multiple sclerosis (MS), a neurological disease, is most often diagnosed between the ages of 20 and 40. More than two-thirds of MS patients are women. They are young and of childbearing age. And the influence of pregnancy on the evolutionary course of multiple sclerosis has been controversial. For a long time, women with MS were advised against having children, arguing that the disease worsened during pregnancy, but especially just after childbirth. This is no longer the case today.
In another scientific study coordinated by the teams of the department of neurology of the CHU Ibn Rochd of Casablanca, the laboratory of genetics and molecular pathology of the faculty of medicine of Casablanca and the laboratory of research on the diseases of the nervous system, neurosensory and handicaps of the same faculty, also published in the June 2022 issue of the Revue Pratique de Médecine, pregnancy is not contraindicated in the case of multiple sclerosis, but must be programmed, with a setting of the date of delivery .
And there are well-defined therapeutic protocols to bring the pregnancy to term and ensure delivery in the most optimal conditions.
The coordinators of this continuing medical education file on pregnancy and neurological diseases, Dr Malika Berrada and Pr Mohammed Abdoh Rafai, affirm that the various neurological diseases, discovered or triggered by pregnancy, require strict collaboration between neurologist, doctor general practitioner, pediatrician, and for certain situations, the anesthetist-resuscitator, for personalized care of each patient.
*Dr Anwar Cherkaoui is a doctor. Winner of the higher cycle of Iscae, he was, for thirty years, the head of medical communication at the CHU Ibn Sina in Rabat.