Epilepsy

Question 1

Criteria for low risk

Answer 1

No seizure in last 10 years- with 5 years off AEDs

Question 2

Diagnosis

Answer 2

Eclampsia unless proven otherwise
Diagnosed by neurologist
MRI and CT are safe in preg

Question 3

Types of seizures

Answer 3

Tonic clonic- highest risk for SUDEP
Stiffening and jerking

Absence- Blank spells with unresponsiveness

Juvenile myoclonic seizures- Myoclonic jerks.
Can be before a tonic clonic seizure.

Focal- Variable, depnds on region affected.

Question 4

Preconception counselling

Answer 4

Type of seizure
Type of AED and dose
Change to lower risk AEDs if possible
5mg Folic acid

Counsel women on stopping AEDs
Address concerns esp with medications

Question 5

Risks of AED

Answer 5

Congential malformations

Valproate (highest risk)- Neural tube defects, facial cleft, hypospdias, Long term effects on development.

Pheno/Phenytoin- congenital heart disorders

Phenytoin and carbamazepine- cleft palate

Lowest risk- Lamotrigene and carabamezapine

Question 6

Seizures in pregnancy

Answer 6

2/3 women remain seizure free
If last seizure >1y ago, 74-92% seizure free
Better if generalised epilepsy, less in focal (60% seizure free)

Question 7

AN care in epilepsy

Answer 7

Obs neuro joint clinics
Serial scans from 28 weeks
Advise pt to register with UK epilepsy and pregnancy register
Routine dating and Mid T scans

Drug level monitoring- might be needed for lamotrigene (70% drop in preg) or Keppra

Question 8

Complications in preg

Answer 8

Increased risk of:
Miscarriage
APH/PPH
HTN in preg
FGR - 3.5x higher risk if on AEDs
IOL/CS
PN depression

Question 9

Intrapartum

Answer 9

Take regular AEDs- oral or IV if needed
Keep hydrated
Early epidural for pain and to allow pt to rest
Benzodiazipines eg clobazam- if high risk for seizures.
Continuous CTG

DO NOT USE Pethedine

Question 10

Seizure in labour

Answer 10

Treat w IV lorazepam 0.1mg/kg or PR/IV diazepam 5-10mg or midazolam 10mg buccal.

Continuous seizure/status- IV phenytoin 10-15mg/kg IV, expedite delivery.

Question 11

PN mx

Answer 11

HIGH risk for seizure- ensure taking AEDs
If AED increased in preg- review in 10days to avoid toxicity
Care in single room
PN depression- high risk
Contraception- Depo or copper coil- not affected by EI AEDs
Give driving advise

Baby-
Monitor for SE - lethargy, diff feeding, crying
Can be breastfed