Epilepsy in pregnancy

Question 1

what is considered pre-eclpamisa or pregnancy

Answer 1

first seziure in second half of pregnancy- pre-eclampsia until proven otherwise

Question 2

how do women with epilepsy seizure risk increase in pregnant

Answer 2

1/3 of pregnant women with epilepsy have an increase in. seziure frequency

Question 3

how does sodium valporate act as a terotogenic agent 8

Answer 3

neurocognitive impairment

ASD

attention defiict disorders

NTDs

hypospadias

heart defect

craniofacial/skeletal anomalies

developmental delay

Question 4

how do antiepileptic drugs affect folic acid

Answer 4

decrease availability of serum folate

therefore advised 5mg/day 1mnth prior to conception

Question 5

how do antiepileptic drugs affect vitamine K
-*how is this manageed

Answer 5

induce fetal hepatic enzyme acitivity-> lower vit K-> neonatal bleeding

*-antenatla vit K administration contraverstial
-KONAKION GIVEN TO ALL NEONATES

Question 6

affects of pregnancy on epilepsy 4

Answer 6

regarding antiepileptic drugs
-decreased compliance
-decreased aboprtion (N+V)
decreased drug levels

impaired sleep

Question 7

what needs to be balanced in management of epilepsy in pregnancy

Answer 7

mantain seizure control against minimising tertogenic risk (use of folic acid)

Question 8

prinicples of management of epilepsy in pregnacy 7

Answer 8

pre-preg counselling

AEd dosage

detailed USS

VIT K

seziures

postnatal

contraception

Question 9

aspects of prepragncy consuelling for women with epilepsy 2

Answer 9

monotherapy ideal

folate supplementate 1mnth before then until 12wk gestation

Question 10

asepcts of AED dosage for women with epilepsy

Answer 10

dosage adjusted on clinical grouds

-fetal risks from AED as well as from not taking the drugs

lamotrigine- increase therapy

Question 11

when does USS take place in women with epilepsy and what is it assessing

Answer 11

detailed USS at 18-22 weeks

-check neural tube, caridac, and craniofacial abnormalites as well as diaphragmatic hernia

Question 12

which women with epilepsy should receive vit K supplementation and when

Answer 12

oral vit K from 36 weeks in women recieivng enzyme-inducing AED to reduce risk of haemorrhagic disease in newborn

-baby should also be given IM Vit K at birth

Question 13

managemnt of sezires in pregnancy for women with epilepsy

Answer 13

most selt limitng

ir prolonged five rectal or IV diazepam or IV lorazepam
-may need intubation

Question 14

postnatal managemnt of women with epilepsy

Answer 14

breast feeding safe as AED levels low for most drug s

Question 15

contraception adivce ofr women with epilepsy

Answer 15

Some AEDs, carbamaepine, phenytoin etc induce liver enzymes so decrease effectiveness of standard dose contracetopins

choose higher dose oestrogen preparation or alternative form