A lady having epileptic seizure with phenytoin therapy and become pregnant, Treatment is :

Ans. is b i.e. Tapering to lowest level of phenytoin and continue pregnancy Choice ot antiepileptic drug Drug absolutely contraindicated (in pregnancy) Valproate, Trimethadione Drugs which should not be used unless - Phenytoin, Carbamazepine absolutely necessary Drug of choice in epilepsy - Phenobarbitone DOC in status epilepticus -- Diazepam So from the above text it is clear that Carbamazepine is as bad as phenytoin therefore, there is no point in replacing phenytoin with Carbamazepine I did not get any text saying pregnancy should be terminated if patient is on phenytoin therapy, what I did get was -- "Since the potential harm of uncontrolled seizures on the mother and fetus is considered greater than the teratogenic effects of antiepileptic drugs, it is currently recommended that pregnant women be maintained on effective drug therapy. When possible, it seems prudent to have the patient on monotherapy at the lowest effective dose, especially during the first trimester. So I will go for option "b" i.e. Tapering to lowest level of phenytoin & continue pregnancy.