Dose adjustment strategy of levetiracetam in pregnant patients with epilepsy: Case report and literature review

Abstract

Rationale: Pregnant patients with epilepsy are prone to preterm delivery, stillbirth, or cesarean section, and their mortality rate is almost 10 times higher than that of normal pregnant women. The potential negative influences of antiepileptic drugs (AEDs) on the fetus are weighed against the necessity for achieving optimal control of seizures. Treatment with AEDs during pregnancy is a major challenge for pregnant women and healthcare teams. Patient concerns: This paper reports two cases of young women diagnosed with pregnancy and epilepsy. Intervention: The dose of levetiracetam was adjusted under the guidance of therapeutic drug monitoring to reduce the effects of seizures on the fetus and the incidence of reproductive toxicity caused by adverse drug reactions. Outcomes: Epilepsy was well controlled in the two pregnant patients, and the newborns had no genetic disorders. Lessons: It is recommended to regularly monitor the serum LEV level in pregnant patients with epilepsy. This practice serves as a foundation for adjusting the drug treatment plan and offering more precise guidance for medication management during pregnancy.