Electroceuticals for Motherhood: Utility of responsive neurostimulation and Proactive antiseizure medication management in two pregnancies

Females with drug-resistant epilepsy (DRE) face unique challenges in balancing seizure control with the teratogenic risks of anti-seizure medications (ASMs) during pregnancy. This case study highlights the use of responsive neurostimulation (RNS) as an electroneuromodulatory strategy to enable safer pregnancies by reducing ASM burden while maintaining seizure control. A 25-year-old woman with bilateral limbic epilepsy secondary to autoimmune encephalitis underwent RNS implantation targeting the hippocampi. Over a multi-year preconception planning period, RNS optimization allowed for tapering of high-risk ASMs and stabilization of seizure frequency. Across two pregnancies, neuromodulation enabled stable epilepsy control and reduced reliance on polytherapy, despite pharmacokinetic ASM variability. Both pregnancies resulted in healthy infants with no major congenital anomalies, despite episodes of breakthrough seizures. This case underscores the transformative potential of RNS in the reproductive care of women with DRE-not only by improving maternal safety but also by reducing fetal exposure to teratogenic drugs. As the first report to demonstrate how RNS can facilitate pregnancy planning with details on how ASM was minimized and complex therapeutic monitoring, this study sets the stage for integrating electroneuromodulation into preconception counselling and epilepsy management for women of childbearing age.