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Is it safe to take Levipil during pregnancy?

Q: My 22 years old daughter is suffering from neurocysticercosis for the past two and a half years. Sometimes, she becomes unconscious for 15 to 30 minutes and her hands & legs shiver. She is taking Levipil (500 mg) (twice in a day). She has been on medication for the past two and a half years. We are now thinking of her marriage. Will she lead a normal life? Will she conceive after her marriage? Is it safe to take Levipil during pregnancy?

A:Neurocysticercosis is a very common parasitic infection in human beings. The parasite spends its life cycle in pigs and human beings; the infection is usually acquired though unwashed, uncooked food items especially pork. It may also be found in vegetarians due to contamination. It reaches the brain and makes a small spherical home for itself called cyst. There may be single or multiple cysts. The parasite dies in a few weeks / months, and the cysts may disappear or form a calcium deposit in brain. This parasite may cause irritation of surrounding brain tissue, which causes the fits / seizures/ convulsions in affected patients. Usually this is a short lived phenomenon, and after a few months, patients may become seizure free. However, in some patients it may cause scarring in the brain which might precipitate fits in future life. Some patients may have a tendency for recurrent neurocysticercosis. Patients with multiple cysts or recurrent neurocysticercosis (NCC) may need lifelong antiepileptic medicines. Some patients may become seizure free, and their medicines may be gradually tapered and stopped. Patients diagnosed with NCC should have a MRI Brain scan with contrast after 6 months of diagnosis, and if this is normal in a patient who is fit-free for more than two and a half years, medicines may be gradually reduced and stopped only after a neurologist’s review and advice, under supervision. Never stop or alter antiepileptic drugs without doctor’s advice. Most patients with controlled seizures can have normal married life and child bearing. They can become pregnant and can have normal deliveries. However, it is unpredictable whether they will have fits / seizures during pregnancy. The safety of LEVETIRACETAM during pregnancy and lactation is not yet established reliably. I would suggest that your daughter first undergoes an MRI scan of Brain with contrast (provided she does not have any other disease or altered kidney functions), and EEG, and then she should consult a Neurologist, who can guide you further if therapy is required, and what drug she should change to. Oxcarbazepine or Carbamazepine is comparatively safer in pregnancy.

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