From May 24 to May 30, National Epilepsy Week is taking place to raise awareness for those affected by epilepsy. Anti-seizure medications (ASMs) can be detected in the breast milk of women with epilepsy and plasma/serum of infants who have consumed breast milk, according to study findings published in Seizure: Journal of Epilepsy.
Deciding whether to discontinue ASMs is a severe concern for half of the women with epilepsy who are of childbearing age.
Many studies have assessed concentrations of ASMs in the breast milk of lactating women with epilepsy, but this is the first systematic review of those concentrations.
Ten studies have been published since 2000. ASMs quantified were carbamazepine (2 studies), lamotrigine (5 studies), primidone and its metabolites (2 studies), levetiracetam (2 studies), ethosuximide (1 study), topiramate (1 study), gabapentin (1 study), and valproic acid (1 study). Nearly all women in most of the studies received at least 2 ASMs.
Overall, antiepileptic drug concentrations in blood samples of breastfed infants were found substantially lower than maternal blood concentrations. Given the well-known benefits of breastfeeding and the prior studies demonstrating no ill effects when the mother was receiving antiepileptic drugs, these findings support the breastfeeding of infants by mothers with epilepsy who are taking antiepileptic drug therapy.
However, it should be noted that relative infant dosage calculations cannot be performed, because breast milk concentrations of AEDs were not quantified. The number of samples in infants was limited to only 1 sample per infant, and determination of concentrations could only be assessed at 1 point between feedings; therefore, results may not reflect total exposure to the infant over time.
For mothers with epilepsy, there is no consensus within the medical community on if breastfeeding while taking antiepileptic drugs could have adverse side effects on their children. While previous studies examined breast milk concentrations of antiepileptic drugs, they did not account for the number of antiepileptic medications metabolized by the child. U of M researchers found that the antiepileptic drug concentrations in blood samples of breastfed infants were substantially lower than maternal blood concentrations.