Last update May 30, 2020

Maternal Epilepsy

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Epileptic disorders are not a contraindication for breastfeeding.

Many Medical Associations like American Academy of Neurology, Spanish Society of Neurology, American Association of Epilepsy and American Academy of Pediatrics among others support breastfeeding in epilepsy affected mothers who are on treatment for this condition.

Many anti-epileptic drugs are compatible with breastfeeding since they are not a cause of harm to the breastfed infant. Phenobarbital, Primidone and Ethosuximide should be avoided because may be a cause of excessive sedation. Avoid felbamate due to risk of hematological and liver toxicity. See info on any particular drug which is offered at our website.

Because some drugs are excreted into breast milk in small amounts an abrupt weaning may trigger a Deprivation Syndrome in the infant (seizures due to sudden drug discontinuation). This is a reason for gradual weaning as the best option.

Non-breastfed newborn babies are at a higher risk of seizures than breastfed ones because of sudden decrease of fetal drug serum levels.

Affected mothers should nurse their babies in a recumbent position or accompanied by a person to assist her in case of seizure or a falling down.


See below the information of this related group:

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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José María Paricio, founder of e-lactancia.
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References

  1. Cabo-Lopez I, Canneti B, Puy-Nunez A. Epilepsia y lactancia materna: del mito a la realidad. [Epilepsy and breastfeeding: from myth to reality]. Rev Neurol. 2019 Jul 16;69(2):68-76. Abstract
  2. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  3. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; for the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group. Breastfeeding in Children of Women Taking Antiepileptic Drugs: Cognitive Outcomes at Age 6 Years. JAMA Pediatr. 2014 Abstract
  4. Reimers A. New antiepileptic drugs and women. Seizure. 2014 Abstract Full text (link to original source) Full text (in our servers)
  5. Van Ness PC. Breastfeeding in women with epilepsy. JAMA Neurol. 2013 Abstract
  6. Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013 Abstract Full text (link to original source) Full text (in our servers)
  7. Geller S, Yagil Y, Biriotti S, Neufeld MY. Breastfeeding with epilepsy: mothers' experiences and the role of professionals, family, and friends. Breastfeed Med. 2013 Abstract
  8. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  9. Davanzo R, Dal Bo S, Bua J, Copertino M, Zanelli E, Matarazzo L. Antiepileptic drugs and breastfeeding. Ital J Pediatr. 2013 Abstract Full text (link to original source) Full text (in our servers)
  10. Klein A. The postpartum period in women with epilepsy. Neurol Clin. 2012 Abstract
  11. Rapcencu AE, Lindhout D, Bulk S. Frequently asked questions on epilepsy, pregnancy and lactation: a EURAP-NL report. Seizure. 2012 Abstract Full text (link to original source) Full text (in our servers)
  12. Mercadé Cerdá JM, Sancho Rieger J, Mauri Llerda JA, López González FJ,Salas Puig X. Guías diagnósticas y terapéuticas de la Sociedad Española de Neurología 2012. 1. Guía oficial de práctica clínica en epilepsia. Guías SEN 2012 Full text (in our servers)
  13. Mintzer S. To test our guess that breast is best: anticonvulsants and breastfeeding. Epilepsy Curr. 2011 Abstract Full text (link to original source) Full text (in our servers)
  14. Klein AM. Epilepsy cases in pregnant and postpartum women: a practical approach. Semin Neurol. 2011 Abstract
  15. Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD Study Group. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010 Nov 30;75(22):1954-60. Abstract Full text (link to original source) Full text (in our servers)
  16. Crawford PM. Managing epilepsy in women of childbearing age. Drug Saf. 2009 Abstract
  17. O'Connor SE, Zupanc ML. Women and epilepsy. J Pediatr Pharmacol Ther. 2009 Abstract Full text (link to original source) Full text (in our servers)
  18. Sabers A, Tomson T. Managing antiepileptic drugs during pregnancy and lactation. Curr Opin Neurol. 2009 Abstract
  19. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, Hopp J, Ting TY, Hauser WA, Thurman D, Kaplan PW, Robinson JN, French JA, Wiebe S, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Shafer PO, Le Guen C; American Academy of Neurology; et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of... Neurology. 2009 Abstract Full text (link to original source) Full text (in our servers)
  20. Rousseau JB. Meeting the needs of the postpartum woman with epilepsy. MCN Am J Matern Child Nurs. 2008 Abstract
  21. Pennell PB, Gidal BE, Sabers A, Gordon J, Perucca E. Pharmacology of antiepileptic drugs during pregnancy and lactation. Epilepsy Behav. 2007 Abstract
  22. Tomson T, Hiilesmaa V. Epilepsy in pregnancy. BMJ. 2007 Abstract Full text (in our servers)
  23. Pennell PB. 2005 AES annual course: evidence used to treat women with epilepsy. Epilepsia. 2006 Abstract Full text (link to original source) Full text (in our servers)
  24. Thomas SV. Management of epilepsy and pregnancy. J Postgrad Med. 2006 Abstract
  25. Tettenborn B. Management of epilepsy in women of childbearing age: practical recommendations. CNS Drugs. 2006 Abstract
  26. Pack AM. Therapy insight: clinical management of pregnant women with epilepsy. Nat Clin Pract Neurol. 2006 Abstract
  27. O'Brien MD, Gilmour-White SK. Management of epilepsy in women. Postgrad Med J. 2005 Abstract Full text (link to original source) Full text (in our servers)
  28. Tomson T. Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding. Ther Drug Monit. 2005 Abstract
  29. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005 Abstract Full text (link to original source) Full text (in our servers)
  30. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8. Abstract
  31. Pennell PB. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology. 2003 Abstract
  32. Hägg S, Spigset O. Anticonvulsant use during lactation. Drug Saf. 2000 Jun;22(6):425-40. Review. Abstract
  33. Bar-Oz B, Nulman I, Koren G, Ito S. Anticonvulsants and breast feeding: a critical review. Paediatr Drugs. 2000 Mar-Apr;2(2):113-26. Review. Abstract
  34. Meyer FP, Quednow B, Potrafki A, Walther H. [Pharmacokinetics of anticonvulsants in the perinatal period]. Zentralbl Gynakol. 1988 Abstract
  35. Kaneko S, Sato T, Suzuki K. The levels of anticonvulsants in breast milk. Br J Clin Pharmacol. 1979 Abstract Full text (link to original source) Full text (in our servers)

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