Epilepsy Flashcards
What is the prevalence of epilepsy in pregnancy
0.5-1%
Most common neurological problem in pregnancy
Enzyme inducing AED’s
Barbiturates Phenytoin Carbamazepine Topiramate Oxcarbazepine Lamotrigine
Barbie Physically Craves Top Oxtail
Risk of major congenital malformations with lamotrigine
2%
Risk of major congenital malformations with carbemazepine <400mg
3.4%
Risk of major congenital malformations in the general population
1-2%
Risk of major congenital malformations with AED monotherapy and poly therapy
Monotherapy 3.7%
Polytherapy 15%
What percentage will have no seizures in pregnancy
What is the most important factor in assessing risk
67%
Seizure free duration
74-92% seizure free if none in past 9-12 months
Define status epilepticus
30 min continual seizure or activity or cluster of seizures without recovery
When is the highest risk of seizures
Postpartum
What is the risk of seizure in labour and postpartum
1-2% in both
What is the risk of SUDEP
0.5-1 in 1000 people with epilepsy
What are the obstetric complications of epilepsy
Spont miscarriage
APH
Hypertensive disorders
LSCS
Higher still if on AED FGR IOL PPH Admission to NNU (only if on AEDs)
What is the dose of emergency contraception if on an enzyme inducer
Levonogestrel 3mg
What is the relationship between lamotrigine and the COCP
The COCP lowers the levels of lamotrigine in the blood and therefore can increase seizure frequency
What is the relationship between enzyme inducers and the COCP
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
What is the prevalence of epilepsy
0.5-1%
By how much is the risk of maternal mortality increased
10x
When are women considered no longer epileptic
Seizure free for 10yr with the last 5 yr off AED’s
Childhood epilepsy, reached adulthood seizure free without AEDs
What is the risk of congenital malformations in epileptics not on AEDs
Same as the population risk which is 1-2%
What is the risk of major malformation if previous child effected
16.8%
By how much is the risk of SGA increased by if taking AEDs
3.5X
Regarding epilepsy
What prophylaxis can be considered in labour and when uncontrolled
What is the risk
Clobazam
Recurrent seizures
Recent seizure provoked by stress or tiredness
Seizure in previous labour
Respiratory depression in newborn
When should a seizure in labour be treated
> 5min duration due to risk of progression to status
How is a seizure in labour treated if IV access
lorazepam IV 0.1mg per kg (usually 4mg )
Repeat after 15 min if needed
Or
Diazepam 5-10mg IV
How is a seizure in labour treated if no IV access
Diazepam 1-20mg pr
Repeat after 15 min if needed
Or
Midazolam 10mg buccal
How is a seizure in labour treated if not controlled with first measures
Phenytoin 10-15mg /kg
Usually 100mg
