Epilepsy

Question 1

What is the prevalence of epilepsy in pregnancy

Answer 1

0.5-1%

Most common neurological problem in pregnancy

Question 2

Enzyme inducing AED’s

Answer 2

Barbiturates
Phenytoin
Carbamazepine
Topiramate
Oxcarbazepine
Lamotrigine

Barbie Physically Craves Top Oxtail

Question 3

Risk of major congenital malformations with lamotrigine

Answer 3

2%

Question 4

Risk of major congenital malformations with carbemazepine <400mg

Answer 4

3.4%

Question 5

Risk of major congenital malformations in the general population

Answer 5

1-2%

Question 6

Risk of major congenital malformations with AED monotherapy and poly therapy

Answer 6

Monotherapy 3.7%

Polytherapy 15%

Question 7

What percentage will have no seizures in pregnancy

What is the most important factor in assessing risk

Answer 7

67%

Seizure free duration
74-92% seizure free if none in past 9-12 months

Question 8

Define status epilepticus

Answer 8

30 min continual seizure or activity or cluster of seizures without recovery

Question 9

When is the highest risk of seizures

Answer 9

Postpartum

Question 10

What is the risk of seizure in labour and postpartum

Answer 10

1-2% in both

Question 11

What is the risk of SUDEP

Answer 11

0.5-1 in 1000 people with epilepsy

Question 12

What are the obstetric complications of epilepsy

Answer 12

Spont miscarriage
APH
Hypertensive disorders
LSCS

Higher still if on AED
FGR
IOL
PPH
Admission to NNU (only if on AEDs)

Question 13

What is the dose of emergency contraception if on an enzyme inducer

Answer 13

Levonogestrel 3mg

Question 14

What is the relationship between lamotrigine and the COCP

Answer 14

The COCP lowers the levels of lamotrigine in the blood and therefore can increase seizure frequency

Question 15

What is the relationship between enzyme inducers and the COCP

Answer 15

Reduce the COCP effectiveness therefore the dose needs to be increased

Start with 50mcg and increase to 75mcg if breakthrough bleeding or consider tricycle her

Question 16

What is the prevalence of epilepsy

Answer 16

0.5-1%

Question 17

By how much is the risk of maternal mortality increased

Answer 17

10x

Question 18

When are women considered no longer epileptic

Answer 18

Seizure free for 10yr with the last 5 yr off AED’s

Childhood epilepsy, reached adulthood seizure free without AEDs

Question 19

What is the risk of congenital malformations in epileptics not on AEDs

Answer 19

Same as the population risk which is 1-2%

Question 20

What is the risk of major malformation if previous child effected

Answer 20

16.8%

Question 21

By how much is the risk of SGA increased by if taking AEDs

Answer 21

3.5X

Question 22

Regarding epilepsy

What prophylaxis can be considered in labour and when uncontrolled

What is the risk

Answer 22

Clobazam

Recurrent seizures
Recent seizure provoked by stress or tiredness
Seizure in previous labour

Respiratory depression in newborn

Question 23

When should a seizure in labour be treated

Answer 23

> 5min duration due to risk of progression to status

Question 24

How is a seizure in labour treated if IV access

Answer 24

lorazepam IV 0.1mg per kg (usually 4mg )
Repeat after 15 min if needed

Or

Diazepam 5-10mg IV

Question 25

How is a seizure in labour treated if no IV access

Answer 25

Diazepam 1-20mg pr
Repeat after 15 min if needed

Or

Midazolam 10mg buccal

Question 26

How is a seizure in labour treated if not controlled with first measures

Answer 26

Phenytoin 10-15mg /kg

Usually 100mg