Epilepsy in pregnancy

Question 1

What is epilepsy in pregnancy?

Answer 1

Continuing tendency to have seizure

Question 2

What is the aetiology and RFs of epilepsy in pregnancy?

Answer 2

Idiopathic

FHx, SOL, previous neurosurgery, head injury, CNS infections.

Question 3

What is the epidemiology of epilepsy in pregnancy?

Answer 3

0.5% pregnancies.

Question 4

What may you find in the history and exam of epilepsy in pregnancy?

Answer 4

Known hx of epilepsy.

Question 5

What is the pathology of epilepsy in pregnancy?

Answer 5

Altered seizure frequency in pregnancy: related to increase in renal and hepatic drug clearance, increased volume of distribution, decreased absorption (eg during labour, emesis etc), compliance issues.

Question 6

What investigations do you do in epilepsy in pregnancy?

Answer 6

Blood: measure anticonvulsant level, FBC (may increase MCV), serum folate, LFT

Fetus: anomaly scan USS, fetal echo.

Question 7

What is the management of epilepsy in pregnancy?

Answer 7

Pre conceptual: maximise control on least teratogenic monotherapy, add folic acid.

Medication: remains the same (benefits outweigh the risk of changing) if well controlled with PHT, LTG, VPO, PHB, LTC.

If diagnosed in pregnancy, LTG/CBX are drugs of choice. Vit K from 36/40.

Delivery: contrinue medications, may reduqire DZP/LZP.

Postnatal: IM Vit K neonate. Gradually reduce maternal epilepsy medicaitons.

Question 8

What are the complications and prognosis of epilepsy in pregnancy?

Answer 8

Maternal: change in seizure frequency, causes 5 maternal deaths py in UK.

Fetal: teratogenicity of AEDs, congenital abnormalities (orofacial, neural tube, heart). Higher risk of childhood epilepsy, HODN (if enzyme inducing drugs taken, Vit K def)

Poorly controlled -> deteriorate. Highest risk peri-partum.