Pregnant Taking Topamax

by Jen
(UK)

Hello.
Basically I was diagnosed 6 years ago with Epilepsy after having one 'Grand Mal' seizure. All scans proved inconclusive, however I have remained on Tablets since and am seizure free.
I want to have a baby and take 50mg per day. My doctor said if I stop taking it I would need to give up my driving license for 12 months, which I dont really want to, however I dont want my baby to have a defect.
Are the tests done on larger doses than my 50mg as it seems my dosage is very low compared to most?
I look forward to hearing from you.

Answer:

Hi Jen,

You don't mention whether or not your doctor is a neurologist or a primary care physician. Since you are in the UK, any advice or answer I give will be based on practice in the USA so please check with your doctor and have a frank discussion with him or her before getting pregnant. The reason I mention all this is that you are way below anti-seizure dosing for this drug and even below the doses we use for headache. Epilepsy, or seizure disorder, means ongoing seizures. Therefore, I would question your diagnosis.

Generally, if someone has been seizure free for 5 years in our clinic and tests are negative, we allow them to taper off the drug.

Ok..let's talk about the drug! Topamax does have a slightly higher incidence of birth defects that that seen in the normal population. This occurs about 1% of the time and in the presence of Topamax the incidence is 2-3% depending on various study outcomes. This is all based on US data but I would assume UK studies are about the same. I do prescribe the medication at low doses for severe migraine during pregnancy and have had patients already on the drug who became pregnant and then stopped it. So far I have not seen any problems, but every woman and every pregnancy is different.

The key here is to talk to a neurologist who specializes in seizures. Believe it or not, in the field of neurology we are all sub-specializing now! Please do not stop the drug yourself without a doctor's clearance. Co-ordinate the care with your ob/gyn doctor as we do. My doctor will not prescribe anything during pregnancy without the ob/gyn approving it first.

As for the driving, I can't comment as here in the US the laws vary state by state.

I wish you the best of luck and hope you have a healthy happy baby someday!

Mary Kay Betz, MS RPA-C
Physician Assistant