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Gaby’s Green Top Guidelines > 2016 68 Epilepsy > Flashcards

2016 68 Epilepsy Flashcards

1
Q

What are the long-term neurological outcomes associated with anti-epileptic drugs?

A

Sodium valproate high risk
Carbamazepine & lamotrigine no risk

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2
Q

What steps should be taken to minimise the risk of congenital abnormalities in epilepsy?

A
  1. Folic acid 5mg from 3 months prior to conception, to end 1st trimester
  2. Lowest effective dose of AED
  3. Medication optimisation prior to conception
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3
Q

What is the effect of pregnancy on seizures?

A

2/3 no seizure deterioration
More likely if seizures in the year prior to conception

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4
Q

How should antenatal care be managed for women with epilepsy?

A
  1. Designated epilepsy care team
  2. Urgent epilepsy specialist review if unexpected pregnancy
  3. Invite to UK Epilepsy & Pregnancy Register
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5
Q

What monitoring for AED levels is recommended in pregnancy?

A

No routine monitoring

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6
Q

What risk factors for seizures should be monitored for in pregnancy?

A
  1. Sleep deprivation
  2. Stress
  3. Non-adherence to AEDs
  4. Seizure type & frequency
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7
Q

With epilepsy in pregnancy, how should the fetus be monitored?

A
  1. Normal dating & anomaly scan
  2. Serial growth scans on SGA pathway
  3. No routine CTGs
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8
Q

What is the role of vitamin K with epilepsy in pregnancy?

A
  1. 1mg IM vit K offered to all
  2. Insufficient evidence for maternal vit K to prevent HDN or PPH
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9
Q

How should seizures be prevented in labour in women with epilepsy?

A
  1. Good care to reduce risk factors
  2. Consider long-acting benzos such as clobazam if high risk for seizures
  3. Continue AEDs during labour
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10
Q

What are the recommendations for analgesia in labour for women with epilepsy?

A
  1. Prioritise pain relief
  2. TENS, Entonox, regional anaesthetic OK
  3. Diamorphine instead of pethidine
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11
Q

When should the AED dose be modified postpartum?

A

Within 10 days if it was increased in pregnancy

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12
Q

What should be the neonatal management following epilepsy in pregnancy?

A
  1. Monitor for adverse effects of AEDs
  2. Encourage breastfeeding
  3. Advise no impact of BF on cognitive outcomes
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13
Q

What contraception can be safely offered with all AEDs?

A
  1. Copper coil
  2. Mirena
  3. Medroxyprogesterone injection
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14
Q

Which AED has levels lowered by combined contraception?

A

Lamotrigine

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15
Q

Which AEDs are enzyme-inducing?

A
  1. Phenytoin
  2. Carbamazepine
  3. Phenobarbital
  4. Primidone
  5. Oxcarbazepine
  6. Eslicarbazepine
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16
Q

Which AEDs are not enzyme-inducing?

A
  1. Sodium valproate
  2. Levetiracetam
  3. Gabapentin
  4. Pregabalin
  5. Vigabatrin
  6. Tiagabine
17
Q

Which emergency contraception should be offered with enzyme-inducing AEDs?

A

Copper coil

18
Q

What is the prevalence of epilepsy?

A

0.5-1%

19
Q

How does pregnancy impact on the risk of death from epilepsy?

A

10x
Majority SUDEP following poorly controlled seizures

20
Q

What are the 4 most common types of epileptic seizures?

A
  1. Tonic-clonic
  2. Absence
  3. Juvenile myoclonic
  4. Focal
21
Q

Which type of seizure are most associated with fetal hypoxia & SUDEP?

A

Tonic-clonic

22
Q

What are the differentials for seizures in pregnancy?

A
  1. Epilepsy
  2. Cerebral venous sinus thrombosis
  3. Posterior reversible leucoencephalopathy syndrome
  4. Space-occupying lesions
  5. Reversible cerebral vasoconstriction syndrome
  6. Syncope
  7. Metabolic: hypoglycaemia, hyponatraemia, Addisonian crisis
23
Q

What are the most common major congenital malformations associated with AEDs?

A
  1. Neural tube defects
  2. Congenital heart disorders
  3. Urinary tract abnormalities
  4. Skeletal abnormalities
  5. Cleft palate
24
Q

What congenital abnormalities does sodium valproate most commonly cause?

A

Neural tube defects
Facial cleft
Hypospadias

25
Q

Which AEDs are most commonly associated with fetal cardiac malformations?

A

Phenobarbital
Phenytoin

26
Q

Which AEDs & at what doses are considered safe in pregnancy?

A

Lamotrigine 300mg
Carbamazepine 400mg

27
Q

Which obstetric complications are more common in epilepsy?

A
  1. Spontaneous miscarriage
  2. APH
  3. Hypertensive disorders
  4. Induction of labour
  5. Caesarean section
  6. Any preterm delivery
  7. Fetal growth restriction
  8. PPH
28
Q

Which obstetric complications are higher in women on AEDs than women with unmedicated epilepsy?

A
  1. Induction of labour
  2. FGR
  3. PPH
  4. NICU admission
29
Q

How much higher are the odds of SGA with AEDs compared to women with unmedicated epilepsy?

A

3.5x

30
Q

How do enzyme-inducing drugs increase the risk of haemorrhagic disease of the newborn?

A

Competitively inhibit the precursors of clotting factors & affect fetal microsomal enzymes that degrade vitamin K

31
Q

What proportion of women with epilepsy have tonic-clonic seizures a) in labour, b) within 24 hours of birth

A

a) 1-2%
b) 1-2%

32
Q

How is a seizure lasting more than 5 minutes managed?

A
  1. Maintenance of airway & oxygenation
  2. Left lateral tilt
  3. IV lorazepam 4mg bolus, further dose after 10-20 mins
    Or PR diazepam 10-20mg, rpt 15 mins
    Or buccal midazolam 10mg
  4. IV phenytoin 10-15mg/kg (1g)
  5. Tocolytics if hypertonus
  6. CS if vaginal birth not imminent
33
Q

What side effects of AEDs can be seen in neonates?

A
  1. Lethargy
  2. Difficulty feeding
  3. Excessive sedation
  4. Withdrawal symptoms
  5. Inconsolable crying
34
Q

Which AEDs transfer most readily into breast milk?

A

Lamotrigine
Levetiracetam
Topiramate

Gaby’s Green Top Guidelines (32 decks)

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