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MRCOG - Part 2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epilepsy

A

Recurrent unprovoked seizures resulting from excessive neuronal discharge

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2
Q

Define SUDEP

A

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.

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3
Q

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

A

0.5-1%

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4
Q

WHAT is the most common cause of SUDEP?

A

Generalized tonic colonic seizures
Or Grand mal seizures

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5
Q

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

A

10 folds

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6
Q

Who we consider as low risk women in pregnancy

A

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

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7
Q

What are the important features of preconception counselling for WWE

A
  1. Compliance with AED
  2. Drug adjustment
  3. Folic acid 5 mg/day
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8
Q

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

A

2 - 2.3%

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9
Q

What are the factors contributing to deterioration of epilepsy in pregnancy

A
  • 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
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10
Q

What are the risk of epileptic fits on fetus?

A
  • Increase risk of IUGR
  • Increase risk of hypoxia
  • Developing childhood epilepsy
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11
Q

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

A
  1. Folic acid supplementation
  2. taking AED at lowest dose, usually monotherapy, avoid sodium valproate
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12
Q

What are thesuggested AED in pregnancy

A

Levoteracetam
Lamotrigine
Carbamazepine

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13
Q

Sodium valproate is associated with which congenital anomalies

A

Facial cleft
NTD
poor cognition & neurodevelopment
hypospadias

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14
Q

Phenobarbital and phenytoin are associated with?

A

Cardiac defects
Fascial cleft

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15
Q

Risk of malformation with sodium valproate

A

6-10%

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16
Q

Risk of malformation with lamotrigine 300 mg

A

2-5%

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17
Q

Risk of malformation with carbamazepine 400 mg

A

2-5%

18
Q

Risk of malformation with levetiracetam

A

7%

19
Q

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

A

16.8%

20
Q

Is there any risk of autism.with AED?

A

Yes

21
Q

When to avoid or postpone pregnancy

A

Uncontrolled epilepsy
drug resistant epilepsy
Non compliance
Polytherapy
High dose AED

22
Q

How we care this patient antenatally?

A
  • 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
23
Q

What is preffered analgesia during labour?

A

TENS, Entonox, regional analgesia

24
Q

Which analgesia is contraindicated

A

Pethidine
increase seizures potential

25
Q

Intrapartum care of WWE

A

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

26
Q

What is the percentage of tonic clonic seizure in labour

A

3-5%

27
Q

Define status epilepticus

A

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

28
Q

What is management of status epilepticus

A
  • 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
29
Q

What period is most vulnerable for seizures

A

Postpartum

30
Q

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

A

10 days

31
Q

Which aed excreted in breast milk

A
  1. Lamotrigen
  2. Levetiracetam
  3. Topiramate
    transfer to larger extent through breast milk
32
Q

What will be the contraception advice for WWE

A
  1. Cu IUD
  2. LNG- IUS
  3. DMPA
33
Q

Emergency contraception for WWE

A

Cu-IUD

34
Q

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

A

Lamotrigine

35
Q

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

A

Eclampsia

36
Q

The effect of pregnancy on epilepsy

A
  • Seizure free: 64%
  • Increased seizure frequency: 17%
  • Decreased seizure frequency: 16%
  • Intrapartum seizures: 3.5%
  • Status epilepticus: <2%
37
Q

At which weeks to perform fetal anomaly scan?

A

18 - 20+6 weeks

38
Q

Do we encourage wwe who are taking aeds to breastfeed?

A

Yes

39
Q

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

A

No they are affected by them

40
Q

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

A

Potential increase in seizures due to fall in levels of lamotrigine

41
Q

Babies born to wwe should be given

A

1 mg of IM VIT K

MRCOG - Part 2 (44 decks)

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