Epilepsy

Question 1

What are causes of seizures in pregnancy?

Answer 1

Eclampsia
Cerebral vein thrombosis
Intracranial mass
Stroke
Hypoglycaemia
Hyponatraemia
Drugs and withdrawal 
Infection 
Epilepsy
Pseudoseizures

Question 2

What management preconception in epilepsy?

Answer 2

Optimise treatment: aim ofr seizure control on lowest dose with avoidance of poly pharmacy to avoid risk of congenital malformation
Folic acid 5mg daily for >3 months prior to conception until delivery
Increased risk of epilepsy in offspring - counsel

Question 3

What antenatal care for epileptic women?

Answer 3

NT and animal scans (may need fetal echo)
IF epilepsy well controlled, stay on AED
If on valproate - may wish to change to (e.g. lamotrigine)
Check folic acid compliance
Use bath only if others home and door unlocked
Vitamin K in last 4 weeks of pregnancy if on hepatic inducing AEDs (baby may have reduced vitamin K dependent clotting factors leading to haemorrhage disease of newborn

Question 4

What are hepatic enzyme inducing AEDs?

Answer 4

Carbemazepine
Ethosuximide
Phenytoin
Primidone
Phenobarbital

Question 5

What intrapartum management?

Answer 5

Aim for vaginal delivery unless obstetric indication for LSCS
Delivery should take place in a hospiral
Continue AED in labour
Epidural is safe in epilespy
Benzodiazepines if seizure is not self temrinating
Seizures more common intrapartum

Question 6

What should be given if seizure is not self-terminating in pregnancy

Answer 6

Lorazepam 4mg IV

Diazepam 10-20mg rectally or IV

Question 7

What postnatal care/counselling?

Answer 7

Give baby vitamin K to reduce haemorrahgic disease of newborn (hepatic enzyme inducing AEDs can cause reduction in vitamin K dependent clotting factors)

Stay in hospital for 24h

Counsel on strategies to avoid dropping baby - change on floor

Encourage breast feeding

Gradually reduce does of AED back to pre-preganncy levels

Discuss contraceptions