A 28-year-old woman with a long-standing history of mesial temporal lobe epilepsy (MTLE) presents to the neurology clinic for preconception counseling. She has been on carbamazepine for seizure control for several years and has remained seizure-free for the past two years. She and her partner are planning to start a family, and she is concerned about the effects of her medication on her pregnancy and the baby’s health. She asks whether she should continue taking carbamazepine, reduce the dose, or switch to a different medication. She also expresses concerns about possible birth defects and whether her epilepsy might worsen during pregnancy. Which of the following statements about managing this patient’s epilepsy during pregnancy is most accurate?
