Q: A 28 y/o F comes to OPD, she is known the case of epilepsy since childhood, taking Valproate and levetiracetam, she has been seizure free since last 11 months, she tells you that she is 8 weeks pregnant, what will you do? Answer: In pregnancy, the incidence of seizure may increase or decrease. But seizure in pregnancy can be potentially dangerous and life-threatening, therefore, the anti-epileptic drugs which patient is taking with optimal control of seizures should be continued and the patient should be counselled about the risk of teratogenicity and benefits. More-over, anti-epileptic drugs increase the risk to 6% as compared to placebo (3%), and among anti-epileptic drug valproate possess the highest risk (up to 20%), newer antiepileptic drugs have a far lower risk of teratogenicity as compared to valproate and topiramate (which have the highest). Alternatively if patient is not pregnant and wants to be pregnant you may choose to wean her off anti-epileptics if more than
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