Epilepsy Flashcards
Facts in epilepsy
3-4/1000 pregnancies
Most common neurological problem encounted in pregnancy
Diagnosis of epilepsy
Diagnosis should be made by a specialist
EEG To support diagnosis but not to exclude it
MRI to identify structural abnormalities
Differential diagnosis for epilepsy
Eclampsia
Drug toxicity
Infection ( meningitis, encephalitis)
Fever
Metabolic disturbances
Space occupying lesions
Stroke
Cerebral vein thrombosis
TTP
MS
head injury
Fertility and epilepsy
Higher incidence of subfertility drug induced
Lower libido
Dyspareunia
Vaginismum
Anovulatory cycles
PCO ( because of valproate)
Effects of pregnancy on epilepsy
30% experience more crisis
60% have no change
10% have reduced
If no seizures in the last 12 months better prognosis for pregnancy
Risk of seizures is highest peripartum 1-2% will have them in labour or within 24 hrs
Status epilepticus
Over 20 minutes
Medical emergency
ABC
Lorazepam - 2 mg bolus every 5 minutes
Load with phenytoin - 18mg/kg
Effective 75-85% cases
Effect on mother with epilepsy
Preterm delivery
Placental abruption
Pre eclampsia
Operative delivery
Effects on fetus if mother epileptic
Weak association between seizures and fetal hypoxia / intracranial haemorrhage
Perinatal mortality is increased
IUGR
fetal malformation - increased risk worse in first trimester, with polytherapy
Defects: neural tube, orofacial cleft, congenital heart defect
Children seem to have lower IQ and higher prevalence of cognitive impairment
Preconception and epilepsy
Confirmation of seizure type
Drug change/ withdrawal
5mg Folic acid
Potential maternal and fetal risk
Antenatal care and epilepsy
MDT
booking scan
Review frequency if seizures and meds
20/40 scan plus cardiac scan
Regular clinical assessment of fetal growth
If on lamotrogine they usually need the dose increased
Postpartum care in epilepsy
Baby needs vitamin k 1 mg
Encourage breastfeeding
Review meds
Strategies to minimise harm to herself and baby
Contraception
