The frequency of seizures may decrease in pregnancy. The patient may present with the first seizure during pregnancy (when investigation is limited) or during the puerperium. Tumours and arteriovenous malformations can enlarge in pregnancy and produce such seizures; however, these causes are rare and most attacks are idiopathic. Cortical venous thrombosis and systemic lupus erythematosus should be considered as alternative explanations. Care must be taken when prescribing treatment in pregnancy although a change or withdrawal of medication is rarely necessary. The role of drugs in teratogenesis is complex; genetic mechanisms in epilepsy account for an increased incidence of birth defects. Over 90% of pregnant women with epilepsy will deliver a normal child.
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