New research provides evidence-based dosing strategies for epilepsy medications in pregnant and postpartum women. The findings, published in Neurology in January 2026, analyzed medication dosing changes observed in women in the US between 2012 and 2016.
Dr. Page Pennell and her colleagues utilized data from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study. Dr. Pennell stated the research's aim was to generate practical evidence for clinicians treating women with epilepsy during pregnancy, noting these strategies are based on real-world data.
Contextual Information
The MBRRACE report, published in 2025, indicated that epilepsy and stroke were among the top five leading causes of maternal death in the UK between 2021 and 2023. A prior MBRRACE report from 2023 showed that deaths from sudden unexpected death in epilepsy (SUDEP) in mothers with epilepsy had doubled between the periods of 2013-2015 and 2019-2021. Epilepsy Action states that individuals with epilepsy face a higher risk of death during pregnancy or within 12 months postpartum compared to those without the condition.
Study Methodology and Findings
The Neurology study involved 299 women, aged 14-45, whose medication doses and seizure activity were monitored during pregnancy and for six weeks after childbirth.
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Overall Medication Adjustments: Approximately 67.8% of epilepsy medications were increased during pregnancy. Following delivery, about 47.9% of these medications were subsequently decreased.
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Lamotrigine Dosing: For women taking lamotrigine, doses were increased in 87.7% of cases during pregnancy, reaching an average of 191% of the original dose taken at conception. By six weeks postpartum, 70.5% of these doses were reduced, averaging 116% of the original dose.
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Levetiracetam Dosing: More than half (56%) of those taking levetiracetam experienced dose increases during pregnancy, averaging 177% of their original dose. Postpartum, 34.4% had their dose reduced to approximately 136% of the original.
The researchers concluded that these medication management strategies contributed to previous MONEAD study findings which indicated no significant difference in seizure control between pregnant and non-pregnant groups. The study suggests these findings are applicable for the management of pregnant women with epilepsy.
Expert Commentary
Tom Shillito, health improvement and research manager at Epilepsy Action, commented on the significance of careful epilepsy management during pregnancy, noting that physiological changes can impact medication efficacy. He highlighted the role of regular monitoring and dose adjustments in maintaining maternal safety. Epilepsy Action is developing guidance for healthcare professionals to support the care of pregnant women with epilepsy, including recommendations for monitoring anti-seizure medicines during and after pregnancy.