Epilepsy

Question 1

Pre-preg counselling key points

Answer 1

• MDI - MFM/Neuro/Genetic
• Aim seizure free >12/12
• Lifestyle - avoid triggers
• Contraception during optimisation
• Genetic counselling re: inheritance
• High dose folate 3/12 prior
• RV & change AED safe for preg (e.g. NaValp)
• Compliance of AED & increase dose
• Risk to baby - from meds
• Risk to mum - SUDEP

Risks to baby
- NTD
- cardiac defects
- Oro-facial cleft

It’s true, all teratogenic but risks assoc with uncontrolled disease is worse, teratogenicity is dose related
Choice of antiepileptic
- lowest dose
- least teratogenic
- eg lamotrigine <300mg daily

Question 2

AN considerations

Answer 2

• Nuchal translucency scan
• Tertiary morphology scan
• +/- Foetal echo
• High dose folate entire preg
• Vit K from 36/40 enzyme inducing AED

Enzyme inducing
- Carbamazepine, phenytoin, phenobarbitone, primidone
- Can cause neonatal coagulopathy

Question 3

Intrapartum considerations

Answer 3

• Time/MOD obs indication
• Birth in hospital
• CEFM
• IV access
• Epidural - stress/pain avoidance
• Proph PO clobazam if recent seizure

Question 4

Postpartum considerations

Answer 4

• nurse on floor/shallow bath/company
• BF -express/store (avoid sleep dep)
• Contraception - all ok if non-enzyme inducing otherwise only Cu/Mirena/MPA
• LMWH APP
• Paed rv - NAS
• Preg interval - >12mo seizure free
• Risk of SUDEP
• Neurology F/U

Question 5

Mx of epileptic seizure in labour

Answer 5

• Emergency
• Call for help
• MDI/simultaneous
• DRABC
• Left lateral/O2/IVC/Bloods/IVT
• IV benzo +/- IV phenytoin
• BP control
• Tocolytic if hypertonus
• NRCTG not recovered within 5 or recurrent seizures -> expedite del