Epilepsy Flashcards
What kind of anti-epileptic is carbamazapine?
Hepatic enzyme inducer
What kind of anti-epileptic is phenytoin?
Hepatic enzyme inducer
What kind of anti-epileptic is phenobarbitol?
Hepatic enzyme inducer
What kind of anti-epileptic is topiramate?
Hepatic enzyme inducer
What kind of anti-epileptic is sodium valproate?
Non hepatic enzyme inducing
What kind of anti-epileptic is lamotrigine?
Non hepatic enzyme inducing
What kind of anti-epileptic is Levetiracepam?
Non hepatic enzyme inducing
Which AED has the highest risk of major congenital abnormality?
sodium valproate
What is the risk of major congenital abnormality with polytherapy of AED?
6-8% (up to 10% if valproate)
What is the risk of major congenital abnormality with sodium valproate?
6-10% (dose dependent)
What is the risk of major congenital abnormality with lamotrigine?
2-5% (dose dependent)
What is the risk of major congenital abnormality with carbamazipine?
2-5% (dose dependent)
What is the risk of major congenital abnormality in a non-epileptic pregnancy?
2-2.3%
Which congenital abnormalities are associated with sodium valproate?
Neural tube defects, cleft palate, cardiac abnormalities, neurodevelopmental delay
Which congenital abnormalities are associated with AEDs?
Cardiac abnormalities, neural tube defects, cleft palate,
What is the advice regarding folic acid and pregnancy for women with epilepsy?
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)
What is the incidence of AED use in pregnancy?
1 in 200 pregnancies
How much does epilepsy increase risk of maternal mortality?
Increases risk 10 fold
What are the risk factors for SUDEP?
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
What are the risks of lamotrigine use in pregnancy?
Lamotrigine excretion increases in pregnancy and therefore doses may become inadequate (can fall by 70%) and need increasing to avoid seizure precipitation
What proportion of women with epilepsy have seizures in pregnancy?
60% have no change in seizure activity, approximately 30% have increasing frequency of seizures, 10% have reduced frequency of seizures
When is risk of seizure highest in pregnancy?
Peripartum - 1-2% risk of seizure
Which pain relief is unsafe in labour?
pethidine (increases seizure threshold)
What are the risks to baby with AEDs?
Congenital malformation
SGA
Hypoxia if mother has seizure
Risk of toxicity/withdrawal after delivery
Risk of haemorrhagic disease of the newborn
What is the rate of SGA with epilepsy?
3.5 x higher than no epilepsy pregnancy
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?
clobazam (benzodiazepam)
What are the signs of AED toxicity e.g. in a postnatal woman?
Diplopia
Drowsiness
Unsteadiness walking
Which contraception should be avoided in patients taking hepatic enzyme inducing anti-epileptics?
oral contraceptives (3 x higher risk of contraceptive failure) Implant
Which contraceptives should be offered to women with hepatic enzyme inducing AEDs?
Depo, IUS or IUCD
Which contraceptive should be avoided with lamotrigine?
COCP - oestrogen lowers serum lamotrigine levels increasing risk of seizure
Which emergency contraceptive should be offered to women with hepatic enzyme inducing AEDs?
Offer IUCD
Evidence for doubling levenogestrel dose weak
Avoid ullipristal
What are the risks of sodium valproate and pregnancy?
10 in 100 risk of congenital malformations e.g. neural tube defect, cleft palate, hypospadius
High risk of neurodevelopmental delay and autism
What was the mortality rate from epilepsy in last MMBRACE report 2020
0.92 in 100000 pregnancies
Risk of developmental disorders with sodium valproate in pregnancy
4 in 10
Risk of congenital abnormalities with sodium valproate in pregnancy
1 in 10
