Management of reproductive risks in people with epilepsy

Epilepsy is a common neurological condition worldwide, presenting unique management challenges for those affected during reproductive age. The effectiveness of contraceptives can be modified by antiseizure medication treatments and pregnancy can alter the pharmacokinetics of antiseizure medications. Furthermore, although treatment with some antiseizure medications convey lifelong risks to offspring, inadequately controlled epilepsy can lead to injury or, in rare cases, death of the mother. In this complex set of circumstances, safe and effective antiseizure medication treatment, evidence-based decision making regarding contraceptive selections, and clear counselling and risk minimisation are imperative. Although risk-benefit decision making has become standard clinical practice for the management of women with epilepsy of childbearing age, reproductive treatment considerations could also be relevant for men. Most young adults with epilepsy live in low-income and middle-income countries, where access to contraceptives, antiseizure medications with adequate safety profiles, and reproductive care and counselling can be scarce. Strategies to optimise care for people with epilepsy in all stages of their reproductive journey must be tailored for resource-limited settings to improve parent-child health worldwide.