While it is probably good for this mother to be treated if she is going
to be driving, most states only require one year seizure free (or less)
for a person with epilepsy to get a driver's license.

Certainly there would be less risk to a 14 mo old than to a young infant
from topamax.  Topamax is only taken twice a day, so she could also
nurse around her peak levels to avoid them, though this is not at all
necessary with a drug classified as L3.

She could also look at her seizure pattern and see if there were any
precipitating factors that she can avoid.  Many people with epilepsy
have more seizures when they are sleep deprived (hence some moms with e
need to pump during the day and have dad give a bottle of expressed milk
at night so they get more uninterrupted sleep), or have taken alcoholic
beverages, or even aspartame.

While topamax is a current favorite anticonvulsant because research has
shown it to be a bit more effective in monotherapy (used alone) than
other anticonvulsants, if the mom is really concerned there are other
choices, such as carbamazepine (tegretol, carbatrol) that have been used
more extensively in breastfeeding women.
Catherine Watson Genna, BS, IBCLC  NYC

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