Epilepsy

Question 1

What kind of anti-epileptic is carbamazapine?

Answer 1

Hepatic enzyme inducer

Question 2

What kind of anti-epileptic is phenytoin?

Answer 2

Hepatic enzyme inducer

Question 3

What kind of anti-epileptic is phenobarbitol?

Answer 3

Hepatic enzyme inducer

Question 4

What kind of anti-epileptic is topiramate?

Answer 4

Hepatic enzyme inducer

Question 5

What kind of anti-epileptic is sodium valproate?

Answer 5

Non hepatic enzyme inducing

Question 6

What kind of anti-epileptic is lamotrigine?

Answer 6

Non hepatic enzyme inducing

Question 7

What kind of anti-epileptic is Levetiracepam?

Answer 7

Non hepatic enzyme inducing

Question 8

Which AED has the highest risk of major congenital abnormality?

Answer 8

sodium valproate

Question 9

What is the risk of major congenital abnormality with polytherapy of AED?

Answer 9

6-8% (up to 10% if valproate)

Question 10

What is the risk of major congenital abnormality with sodium valproate?

Answer 10

6-10% (dose dependent)

Question 11

What is the risk of major congenital abnormality with lamotrigine?

Answer 11

2-5% (dose dependent)

Question 12

What is the risk of major congenital abnormality with carbamazipine?

Answer 12

2-5% (dose dependent)

Question 13

What is the risk of major congenital abnormality in a non-epileptic pregnancy?

Answer 13

2-2.3%

Question 14

Which congenital abnormalities are associated with sodium valproate?

Answer 14

Neural tube defects, cleft palate, cardiac abnormalities, neurodevelopmental delay

Question 15

Which congenital abnormalities are associated with AEDs?

Answer 15

Cardiac abnormalities, neural tube defects, cleft palate,

Question 16

What is the advice regarding folic acid and pregnancy for women with epilepsy?

Answer 16

5mg OD for 3 months pre-conception to end of 1st trimester (Neural tube is formed on day 26 so no benefit starting after day 30)

Question 17

What is the incidence of AED use in pregnancy?

Answer 17

1 in 200 pregnancies

Question 18

How much does epilepsy increase risk of maternal mortality?

Answer 18

Increases risk 10 fold

Question 19

What are the risk factors for SUDEP?

Answer 19

Changing, stopping, poor compliance, inadequate dose of AED
Nocturnal seizures or tonic clonic seizures
Poor seizure control pre-conception
Triggers/risk factors: Poor sleep, stress, Living alone, Learning difficulties, Infrequent neurology input

Question 20

What are the risks of lamotrigine use in pregnancy?

Answer 20

Lamotrigine excretion increases in pregnancy and therefore doses may become inadequate (can fall by 70%) and need increasing to avoid seizure precipitation

Question 21

What proportion of women with epilepsy have seizures in pregnancy?

Answer 21

60% have no change in seizure activity, approximately 30% have increasing frequency of seizures, 10% have reduced frequency of seizures

Question 22

When is risk of seizure highest in pregnancy?

Answer 22

Peripartum - 1-2% risk of seizure

Question 23

Which pain relief is unsafe in labour?

Answer 23

pethidine (increases seizure threshold)

Question 24

What are the risks to baby with AEDs?

Answer 24

Congenital malformation
SGA
Hypoxia if mother has seizure
Risk of toxicity/withdrawal after delivery
Risk of haemorrhagic disease of the newborn

Question 25

What is the rate of SGA with epilepsy?

Answer 25

3.5 x higher than no epilepsy pregnancy

Question 26

Which medication might be used to avoid seizures in labour for a woman who has previously had seizure in labour or has had a recent seizure in pregnancy?

Answer 26

clobazam (benzodiazepam)

Question 27

What are the signs of AED toxicity e.g. in a postnatal woman?

Answer 27

Diplopia Drowsiness Unsteadiness walking

Question 28

Which contraception should be avoided in patients taking hepatic enzyme inducing anti-epileptics?

Answer 28

``` oral contraceptives (3 x higher risk of contraceptive failure) Implant ```

Question 29

Which contraceptives should be offered to women with hepatic enzyme inducing AEDs?

Answer 29

Depo, IUS or IUCD

Question 30

Which contraceptive should be avoided with lamotrigine?

Answer 30

COCP - oestrogen lowers serum lamotrigine levels increasing risk of seizure

Question 31

Which emergency contraceptive should be offered to women with hepatic enzyme inducing AEDs?

Answer 31

Offer IUCD Evidence for doubling levenogestrel dose weak Avoid ullipristal

Question 32

What are the risks of sodium valproate and pregnancy?

Answer 32

10 in 100 risk of congenital malformations e.g. neural tube defect, cleft palate, hypospadius High risk of neurodevelopmental delay and autism

Question 33

What was the mortality rate from epilepsy in last MMBRACE report 2020

Answer 33

0.92 in 100000 pregnancies

Question 34

Risk of developmental disorders with sodium valproate in pregnancy

Answer 34

4 in 10

Question 35

Risk of congenital abnormalities with sodium valproate in pregnancy

Answer 35

1 in 10