Pharmacokinetic changes for newer antiepileptic drugs and seizure control during pregnancy

Epilepsy is a common neurological problem in the patient population, which presents a unique management challenge for women with epilepsy (WWE) during pregnancy, controlling the risks of increased seizure frequency to maternal and fetal during pregnancy and lowering fetal exposure to antiepileptic drugs (AEDs).Previous studies on the changes in the clearance of newer antiepileptic drugs during pregnancy were more limited, particularly for LEV and OXC, and our study extended the available data on the pharmacokinetic changes for newer AED during pregnancy.Newer AEDs, including LTG, LEV, and OXC, have a pronounced increase in apparent oral clearance and decreased plasma concentration during pregnancy. TDM monitoring of these newer AEDs is important for poorly controlled and well-controlled patients. We would encourage at least one monitoring every trimester and probably more frequently for women with poorly seizure control before pregnancy, and dose adjustment should keep up with clearance changes that cannot be predicted prospectively. Moreover, given the considerable variability of risk factors associated with deterioration of seizure control during pregnancy, we should also focus on pre-pregnancy counseling and seizure control before pregnancy for WWE.