Epilepsy Flashcards
Define epilepsy
Recurrent unprovoked seizures resulting from excessive neuronal discharge
Define SUDEP
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.
What is the prevalence of epilepsy in.child bearing age?
0.5-1%
WHAT is the most common cause of SUDEP?
Generalized tonic colonic seizures
Or Grand mal seizures
How much is the risk of death increases in pregnant women with epilepsy
10 folds
Who we consider as low risk women in pregnancy
10 years no seizure attack or 5 years is well controlled without AEDS
What are the important features of preconception counselling for WWE
- Compliance with AED
- Drug adjustment
- Folic acid 5 mg/day
What is the risk of congenital anomaly in WWE not taking AED
2 - 2.3%
What are the factors contributing to deterioration of epilepsy in pregnancy
- 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
What are the risk of epileptic fits on fetus?
- Increase risk of IUGR
- Increase risk of hypoxia
- Developing childhood epilepsy
What are the medication you will prescribe pre conceptual and in early pregnancy for WWE
- Folic acid supplementation
- taking AED at lowest dose, usually monotherapy, avoid sodium valproate
What are thesuggested AED in pregnancy
Levoteracetam
Lamotrigine
Carbamazepine
Sodium valproate is associated with which congenital anomalies
Facial cleft
NTD
poor cognition & neurodevelopment
hypospadias
Phenobarbital and phenytoin are associated with?
Cardiac defects
Fascial cleft
Risk of malformation with sodium valproate
6-10%
Risk of malformation with lamotrigine 300 mg
2-5%
Risk of malformation with carbamazepine 400 mg
2-5%
Risk of malformation with levetiracetam
7%
If 1 child has congenital anomalies what is the risk of recurrence in next child
16.8%
Is there any risk of autism.with AED?
Yes
When to avoid or postpone pregnancy
Uncontrolled epilepsy
drug resistant epilepsy
Non compliance
Polytherapy
High dose AED
How we care this patient antenatally?
- 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
What is preffered analgesia during labour?
TENS, Entonox, regional analgesia
Which analgesia is contraindicated
Pethidine
increase seizures potential
Intrapartum care of WWE
Avoid stress, hyper ventilation or sleep deprivation.
AED should be continue in labour
If high risk of seizure manage with benzodizapine
CEFM
What is the percentage of tonic clonic seizure in labour
3-5%
Define status epilepticus
Seizure lasting for more than 5 mins or having more than 1 seizure without any break in 5 mins
What is management of status epilepticus
- 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
What period is most vulnerable for seizures
Postpartum
If AED dose increases in pregnancy what time duration in which we have to taper it off postpartum
10 days
Which aed excreted in breast milk
- Lamotrigen
- Levetiracetam
- Topiramate
transfer to larger extent through breast milk
What will be the contraception advice for WWE
- Cu IUD
- LNG- IUS
- DMPA
Emergency contraception for WWE
Cu-IUD
Which antiepileptic has the least risk of malformations in the fetus?
Lamotrigine
If there is no history of epilepsy and a fit of seizures presented in 2nd trimester treat it as:
Eclampsia
The effect of pregnancy on epilepsy
- Seizure free: 64%
- Increased seizure frequency: 17%
- Decreased seizure frequency: 16%
- Intrapartum seizures: 3.5%
- Status epilepticus: <2%
At which weeks to perform fetal anomaly scan?
18 - 20+6 weeks
Do we encourage wwe who are taking aeds to breastfeed?
Yes
Do we use levonorgestrel or ulipristal acetate as emergency contraceptives in wwe taking enzyme inducing aed?
No they are affected by them
Women taking lamotrigine monotherapy and estrogen containing contraception should be informed that
Potential increase in seizures due to fall in levels of lamotrigine
Babies born to wwe should be given
1 mg of IM VIT K
Do lamotrigine crosses in breast milk
Yes, so women must be encouraged to breastfeed before taking the medication
