Over 25,000 epileptic women deliver viable pregnancies each year in the United States. Although medical management is the first line of treatment, many physiological changes associated with pregnancy can make optimal treatment challenging. Medication dosage is adjusted based on side effects and seizure frequency, with the goal being no seizures with the lowest medication dosage(s) and side-effect profile possible. Whenever possible, monotherapy is preferred. Many antiepileptic drugs have teratogenic potential, so preconceptional optimization of medication dosage(s) is recommended. Epilepsy has associated neurological comorbidities, the most common being migraines and sleep disorders.