Epilepsy

Question 1

Define epilepsy

Answer 1

Recurrent unprovoked seizures resulting from excessive neuronal discharge

Question 2

Define SUDEP

Answer 2

Sudden unexpected witnessed or unwitnessed, non traumatic and non drowning death in a patient with epilepsy with or without evidence of a seizure and excluding documented status epilepticus in which postmortem doesn’t reveal a toxicology or anatomic cause of death.

Question 3

What is the prevalence of epilepsy in.child bearing age?

Answer 3

0.5-1%

Question 4

WHAT is the most common cause of SUDEP?

Answer 4

Generalized tonic colonic seizures
Or Grand mal seizures

Question 5

How much is the risk of death increases in pregnant women with epilepsy

Answer 5

10 folds

Question 6

Who we consider as low risk women in pregnancy

Answer 6

10 years no seizure attack or 5 years is well controlled without AEDS

Question 7

What are the important features of preconception counselling for WWE

Answer 7

1. Compliance with AED
2. Drug adjustment
3. Folic acid 5 mg/day

Question 8

What is the risk of congenital anomaly in WWE not taking AED

Answer 8

2 - 2.3%

Question 9

What are the factors contributing to deterioration of epilepsy in pregnancy

Answer 9

• Poorly contolled epilepsy prior to pregnancy
• Seizure frequency of more than
  1 per month
• Multiple seizure type
• Drug resistant epilepsy
• High dose polytherapy
• Poor compliance
• Reduce drug concentrations due to increase clearance and pregnancy.
• Specific Nausea, vomiting, sleep deprivation, labour pain and hyperventilation

Question 10

What are the risk of epileptic fits on fetus?

Answer 10

• Increase risk of IUGR
• Increase risk of hypoxia
• Developing childhood epilepsy

Question 11

What are the medication you will prescribe pre conceptual and in early pregnancy for WWE

Answer 11

1. Folic acid supplementation
2. taking AED at lowest dose, usually monotherapy, avoid sodium valproate

Question 12

What are thesuggested AED in pregnancy

Answer 12

Levoteracetam
Lamotrigine
Carbamazepine

Question 13

Sodium valproate is associated with which congenital anomalies

Answer 13

Facial cleft
NTD
poor cognition & neurodevelopment
hypospadias

Question 14

Phenobarbital and phenytoin are associated with?

Answer 14

Cardiac defects
Fascial cleft

Question 15

Risk of malformation with sodium valproate

Answer 15

6-10%

Question 16

Risk of malformation with lamotrigine 300 mg

Answer 16

2-5%

Question 17

Risk of malformation with carbamazepine 400 mg

Answer 17

2-5%

Question 18

Risk of malformation with levetiracetam

Answer 18

7%

Question 19

If 1 child has congenital anomalies what is the risk of recurrence in next child

Answer 19

16.8%

Question 20

Is there any risk of autism.with AED?

Answer 20

Yes

Question 21

When to avoid or postpone pregnancy

Answer 21

Uncontrolled epilepsy
drug resistant epilepsy
Non compliance
Polytherapy
High dose AED

Question 22

How we care this patient antenatally?

Answer 22

• 5mg folic acid pre conception and
  12 weeks
• Manage as low risk and high risk
  In high risk MDT
• Individualize the frequency of visits and at each visit ensure involving other specialities
• avoid triggers
• ensure AED compliance
• asses seizure frequency
  -consider AED level
• Serial growth scan from 28 weeks

Question 23

What is preffered analgesia during labour?

Answer 23

TENS, Entonox, regional analgesia

Question 24

Which analgesia is contraindicated

Answer 24

Pethidine
increase seizures potential

Question 25

Intrapartum care of WWE

Answer 25

Avoid stress, hyper ventilation or sleep deprivation. **AED should be continue in labour** If high risk of seizure manage with benzodizapine CEFM

Question 26

What is the percentage of tonic clonic seizure in labour

Answer 26

3-5%

Question 27

Define status epilepticus

Answer 27

Seizure lasting for more than 5 mins or having more than 1 seizure without any break in 5 mins

Question 28

What is management of status epilepticus

Answer 28

- Left lateral - Oxygen - IVlorazepam 0.1mg/kg - Diazepam 5-10 mg I/ v as alternative *If no IVaccess then p/r 10-20 mg diazepam* *If seizure not control then phenytoin 10-15 mg/kg IV* *if no IV access then give diazepam 10-20 mg rectally repeat after 15 minutes if needed.* - Prevention tongue bite protection

Question 29

What period is most vulnerable for seizures

Answer 29

Postpartum

Question 30

If AED dose increases in pregnancy what time duration in which we have to taper it off postpartum

Answer 30

10 days

Question 31

Which aed excreted in breast milk

Answer 31

1. Lamotrigen 2. Levetiracetam 3. Topiramate *transfer to larger extent through breast milk*

Question 32

What will be the contraception advice for WWE

Answer 32

1. Cu IUD 2. LNG- IUS 3. DMPA

Question 33

Emergency contraception for WWE

Answer 33

Cu-IUD

Question 34

Which antiepileptic has the least risk of malformations in the fetus?

Answer 34

Lamotrigine

Question 35

If there is no **history of epilepsy** and a fit of seizures presented in **2nd trimester** treat it as:

Answer 35

Eclampsia

Question 36

The effect of pregnancy on epilepsy

Answer 36

* Seizure free: 64% * Increased seizure frequency: 17% * Decreased seizure frequency: 16% * Intrapartum seizures: 3.5% * Status epilepticus: <2%

Question 37

At which weeks to perform fetal anomaly scan?

Answer 37

18 - 20+6 weeks

Question 38

Do we encourage wwe who are taking aeds to breastfeed?

Answer 38

Yes

Question 39

Do we use levonorgestrel or ulipristal acetate as emergency contraceptives in wwe taking enzyme inducing aed?

Answer 39

No they are affected by them

Question 40

Women taking lamotrigine monotherapy and estrogen containing contraception should be informed that

Answer 40

Potential increase in seizures due to fall in levels of lamotrigine

Question 41

Babies born to wwe should be given

Answer 41

1 mg of IM VIT K

Question 42

Do lamotrigine crosses in breast milk

Answer 42

Yes, so women must be encouraged to breastfeed before taking the medication