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A. MLA Map Obstetrics and Gynaecology > Epilepsy in Pregnancy > Flashcards

Epilepsy in Pregnancy Flashcards

1
Q

Epilepsy is chronic condition where the occurence of recurring and unpredictable seizures, where neurons in the brain fire when they shouldnt. How many unprovoked (no known cause or precipitatking factor) seizures need to occur before a patient is diagnsoed with epilepsy?

1 - 1
2 - >2
3 - >4
4 - >10

A

2 - >2
- MUST be separated by >24 hours

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2
Q

When defining the term epilepsy we need to understand 2 terms; seizure and unprovoked. In relation to epilepsy what does unprovoked mean?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure or the precipitating factor is unknown
4 - all of the above

A

3 - cause of seizure or the precipitating factor is unknown

  • no medically reversible cause (alcohol, blood glucose) can be identified
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3
Q

What is a provoked seizure?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure is identified but not the precipitating factor
4 - cause of seizure or the precipitating factor is known

A

4 - cause of seizure or the precipitating factor is known

  • diabetes, neurological disorder, alcohol withdrawal
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4
Q

What % of the population are affected by epilepsy?

1 - 0.1 - 1%
2 - 10-15%
3 - 15-30%
4 - 30-50%

A

1 - 0.1 - 1%
- 0.5% of those affected by epilepsy can then become pregnant

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5
Q

Primary epilepsy is idiopathic, where there is no known cause. Secondary epilepsy is when there is an identifiable cause of the epilepsy. Which of the following is NOT typically a cause of epilepsy in pregnancy?

1 - Cerebral hemispheres surgery
2 - Intracranial mass lesion
3 - Antiphospholipid syndrome
4 - Eclampsia
5 - Cerebral vein thrombosis
6 - Thrombotic thrombocytopenic purpura
7 - Myocardial infarction

A

7 - Myocardial infarction
- Stroke/ intracranial haemorrhage is more likely to cause secondary epilepsy

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6
Q

Are patients that have epileptic seizures, always diagnosed with epilepsy prior to pregnancy?

A
  • no
  • patients need to be investigated and secondary causes of epilepsy need to be ruled out
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7
Q

Although there is a myriad of tests that can be performed for in a patient that has experienced seizures, which of the following is the LEAST important test to perform?

1 - Blood pressure and urinalysis
2 - FBC with clotting screen
3 - Electrocardiograph (ECG)
4 - Blood glucose with serum electrolytes
5 = LFTs and U&Es
6 - Brain imaging: CT or MRI
7 EEG= Electroencephalography

A

3 - Electrocardiograph (ECG)
- may be important but is unlikely to identify a secondary cause of epilepsy

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8
Q

Epilepsy is chronic condition where the occurence of recurring and unpredictable seizures, where neurons in the brain fire when they shouldnt. How many unprovoked (no known cause or precipitatking factor) seizures need to occur before a patient is diagnsoed with epilepsy?

1 - 1
2 - >2
3 - >4
4 - >10

A

2 - >2
- MUST be separated by >24 hours

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9
Q

When defining the term epilepsy we need to understand 2 terms; seizure and unprovoked. In relation to epilepsy what does unprovoked mean?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure or the precipitating factor is unknown
4 - all of the above

A

3 - cause of seizure or the precipitating factor is unknown

  • no medically reversible cause (alcohol, blood glucose) can be identified
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10
Q

What is a provoked seizure?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure is identified but not the precipitating factor
4 - cause of seizure or the precipitating factor is known

A

4 - cause of seizure or the precipitating factor is known

  • diabetes, neurological disorder, alcohol withdrawal
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11
Q

What is the term given in epilepsy when a seizure affects both hemispheres?

1 - unprovoked
2 - generalised
3 - systemic
4 - central

A

2 - generalised

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12
Q

Can partial / focal seizures develop into generalised seizures?

A

yes
- called a secondary generalised seizure

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13
Q

A generalised seizure is when both hemispheres are affected. There are subcategories of generalised seizures. Which of the following is NOT a form of generalised seizure?

1 - tonic
2 - atonic
3 - complex partial
4 - clonic
5 - tonic-clonic
6 - myoclonic
7 - absence

A

3 - complex partial

  • tonic = stiff and flexed, patients fall backwards
  • atonic = relaxed, patients fall forwards
  • clonic = violent convulsions
  • tonic-clonic = mixture
  • myoclonic = small muscle twitches
  • absence = patient spaces out
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14
Q

A generalised seizure is when both hemispheres are affected. There are subcategories of generalised seizures. Which of the this subcategories is most common?

1 - tonic
2 - atonic
3 - clonic
4 - tonic-clonic
5 - myoclonic
6 - absence

A

4 - tonic-clonic
- phases of violent convulsions mixed with relaxed muscles

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15
Q

Some patients may experience a preceding prodrome that can last hours to days prior to a seizure, typically of the temporal lobe causing a change in mood or behaviour. They can also experience an aura. Typically what do patients with an aura experience?

1 - strange feeling in the gut
2 - deja vu
3 - strange smells
4 - flashing lights
5 - all of the above

A

5 - all of the above

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16
Q

Does a aura suggest a focal/partial or generalised seizure?

A
  • focal seizure
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17
Q

There are different things that can occur in seizures. Which of the following is the definition of prodrome?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

2 - feeling, sensations, changes in behaviour hours or days before the event
- a lot of the time it can be family or friends who aware of the changes

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18
Q

There are different things that can occur in seizures. Which of the following is the definition of preictal/aura ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

4 - immediately prior (not always present)

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19
Q

There are different things that can occur in seizures. Which of the following is the definition of Ictal?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

3 - actual event (may need witness description)
- typically associated with amnesia

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20
Q

There are different things that can occur in seizures. Which of the following is the definition of post-ictal ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

1 - drowsy, confused, psychotic. Bitten tongue, lost continence

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21
Q

What is an automatism?

1 - voluntary movements following a seizure
2 - involuntary movement following a seizure
3 - coordinated involuntary motor activity
4 - voluntary coordinated movement

A

3 - coordinated involuntary motor activity
- typically occur during the seizure
- typically associated with amnesia and impaired awareness

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22
Q

Automatisms are coordinated involuntary motor activity that typically occur during the seizure and are typically associated with amnesia and impaired awareness. Anywhere can be affected, but which 2 of the following body parts are most commonly affected?

1 - mouth
2 - feet
3 - abdomen
4 - hands

A

1 - mouth
- chewing or lip smacking

4 - hands
- picking or fidgeting

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23
Q

What is an absence seizure?

1 - a seizure where patients lose consciousness
2 - a seizure where patients lose awareness of their surrounding for a period of time
3 - a seizure that has a stiff followed by involuntary actions
4 - combination of all of the above

A

2 - a seizure where patients lose awareness of their surrounding for a period of time
- looks like patient may be day dreaming
- dysfunction between cortex and thalamus

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24
Q

In a generalised (affecting the the whole brain) tonic-clonic seizure, there is a tonic phase (stiffening of the body) followed by a clonic phase (violent/jerking of the body). In the image below which is tonic and which is clonic?

A

A = tonic
- tonic (stiff) phase due to prolonged depolarization due to loss of GABA inhibition
- affected tissue cannot relax

B = clonic
- clonic (jerk) phase due to some neuronal repolarization
- following inactivity all tissues are stimulated quickly at one

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25
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. Which of these does the patient typically remain concious?

A
  • simple partial seizures
  • patient is typically aware of what is happening and will remember
26
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In simple partial seizures the patient is generally concious, is aware and will remember what happened. Which of the following typically occur during a simple partial seizures?

1 - strange sensations (smells, tastes etc..)
2 - jerking of muscles
3 - jacksonian march
4 - all of the above

A

4 - all of the above
- jacksonian march = small jerking of muscles spreads to surrounding areas increasing the jerking movements

27
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In complex partial seizures the patient is generally unconcious. Which of the following typically occur during a complex partial seizures?

1 - loss of consciousness
2 - impaired awareness
3 - memory may be impaired
4 - all of the above

A

4 - all of the above

28
Q

In a generalised (affecting the the whole brain) tonic-clonic seizure, there is a tonic phase (stiffening of the body) followed by a clonic phase (violent/jerking of the body). In the image below which is tonic and which is clonic?

A

A = tonic
- tonic (stiff) phase due to prolonged depolarization due to loss of GABA inhibition
- affected tissue cannot relax

B = clonic
- clonic (jerk) phase due to some neuronal repolarization
- following inactivity all tissues are stimulated quickly at one

29
Q

A tonic-clonic seizure is typically a dramatic effect where patients become stiff, bilateral jerking and post seizure confusion and sleepiness. What can happen in a pregnant women who have a tonic-clonic seizure?

1 - baby is protected
2 - placenta abruption
3 - placenta previa
4 - high risk of Sudden Unexpected Death in Epilepsy

A

4 - high risk of Sudden Unexpected Death in Epilepsy
- also a period of hypoxia in the baby

30
Q

Absence seizures are generalised seizures consisting of brief blank spells with unresponsiveness and a rapid recovery. What can happen in a pregnant women who have an absence seizure?

1 - baby is protected
2 - increase risk of tonic-clonic seizures
3 - placenta previa
4 - high risk of Sudden Unexpected Death in Epilepsy

A

2 - increase risk of tonic-clonic seizures

31
Q

Juvenile myoclonic epilepsy are myoclonic jerks (rapid muscle jerks) that can precede tonic-clonic seizures which are generalised seizures. Which of the following can happen in a pregnant women who have juvenile myoclonic seizures?

1 - an be caused by sleep deprivation
2 - can occur soon after waking
3 - can occur upon waking-up
4 - can lead to dropping of items, including the baby
5 - all of the above

A

5 - all of the above

32
Q

Focal seizures can affect consciousness (complex partial) or not (simple partial). What can happen in a pregnant women who have an absence seizure?

1 - risk of injury/fracture
2 - dental/head injury
3 - high risk of Sudden Unexpected Death in Epilepsy
4 - all of the above

A

4 - all of the above

33
Q

In someone with epilepsy, does pregnancy influence the number of seizures?

A
  • no
  • 64%: remained unchanged throughout pregnancy
  • 17%: had an increase
  • 16%: decrease in seizures in pregnancy
34
Q

Which point in pregnancy can increase the risk of seizure in epilepsy?

1 - ante-natal
2 - labour
3 - post-partum
4 - no different between these

A

3 - post-partum

High risk for exacerbation of seizure frequency due to:
- increased stress
- sleep deprivation
- missed medication
- anxiety

35
Q

Which of the following is NOT a characteristic of Sudden unexplained death in epilepsy (SUDEP)?

1 - sudden, unexpected, nontraumatic and non-drowning death in patients with epilepsy
2 - including status epilepticus
3 - rare cause of death in/after pregnancy
4 - risk factors include uncontrolled epilepsy, women on multiple
anti-epileptic drugs
5 - early onset epilepsy.

A

2 - including status epilepticus
- status epilepticus must be excluded

36
Q

Does epilepsy increase the risk of obstetric complications?

A
  • yes

All of the following are slightly raised in epileptic patients when pregnant:

  • spontaneous miscarriage
  • antepartum haemorrhage
  • hypertensive disorders
  • induction of labour
  • caesarean section
  • fetal growth restriction
  • postpartum haemorrhage
37
Q

Can short episodes of hypoxia affect babies health?

A
  • no
  • baby can tolerate short episodes of hypoxia
38
Q

What affect can a maternal tonic-clonic convulsion have on the foetus?

1 - foetal bradycardia
2 - foetal tachycardia
3 - foetal death
4 - all of the above

A

1 - foetal bradycardia

39
Q

Status epilepticus is when a seizure lasts longer >5 minutes in duration. Why is this serious?

1 - can increase risk of subsequent seizures
2 - increases risk of drug toxicity
3 - increases risk of self harm
4 - medical emergency

A

4 - medical emergency
- typically tonic-clonic affecting both hemispheres
- can lead to permanent brain damage and death
- mortality is between 10-15%

40
Q

In a pregnant women with epilepsy, what effect can status epilepticus have on the foetus?

1 - hypoxia and death
2 - hypoxia and neural development impairments
3 - hypoxia and limb development dyusfunction
4 - all of the above

A

2 - hypoxia and neural development impairments

41
Q

Are all anti-epileptic drugs (AEDs) safe throughout pregnancy?

A
  • no
  • some have teratogenic effects
42
Q

Which 2 of the following anti-epileptic drugs (AEDs) are most likely to cause Neural tube defects?

1 - valproate
2 - carbamazepine
3 - phenytoin
4 - carbamezepine

A

1 - valproate
- (1-3.8%)

2 - carbamazepine
- (0.51%)

There are also other conditions, but specific drug links are unknown, incljuding:

Fetal anticonvulsant syndrome = group of malformations that can affect some babies if they are exposed to certain medicines, known as antiepileptic drugs (AEDs), while in the womb

Hypospadius = a congenital condition in males in which the opening of the urethra is on the underside of the penis

43
Q

Which of the following anti-epileptic drugs (AEDs) is NOT linked with Orofacial clefts?

1 - phenytoin
2 - carbamezepine
3 - valproate
4 - phenobarbitone

A

3 - valproate

There are also other conditions, but specific drug links are unknown, incljuding:

Fetal anticonvulsant syndrome = group of malformations that can affect some babies if they are exposed to certain medicines, known as antiepileptic drugs (AEDs), while in the womb

Hypospadius = a congenital condition in males in which the opening of the urethra is on the underside of the penis

44
Q

Which of the following anti-epileptic drugs (AEDs) is NOT linked with congenital heart defects?

1 - carbamezepine
2 - phenytoin
3 - phenobarbitone
4 - valproate

A

1 - carbamezepine

There are also other conditions, but specific drug links are unknown, incljuding:

Fetal anticonvulsant syndrome = group of malformations that can affect some babies if they are exposed to certain medicines, known as antiepileptic drugs (AEDs), while in the womb

Hypospadius = a congenital condition in males in which the opening of the urethra is on the underside of the penis

45
Q

What should be taken in patients with epilepsy, or those at high risk of epilepsy to reduce the risk of neural tube defects?

1 - vitamin B
2 - vitamin B12
3 - iron
4 - folic acid

A

4 - folic acid
- 5mg/day including pre-conception

  • patients should be on lowest dose of anti-epileptic drugs and least teratogenic
46
Q

Which is the most teratogenic drug in epilepsy that should try to be avoided in pregnancy?

1 - carbamezepine
2 - phenytoin
3 - phenobarbitone
4 - sodium valproate

A

4 - sodium valproate

  • should also try to switch from multiple to one drug during pregnancy
47
Q

When patients with epilepsy are considering becoming pregnant, it is important to provide information relating to anti-epileptic drugs (AED), including which of the following?

1 - screening tests (combined etc)
2 - risks of self discontinuation of AEDs
3 - risksof seizures and AEDs on the fetus, pregnancy, breastfeeding and contraception
4 - all of the above

A

4 - all of the above

48
Q

Patient with epilepsy who are pregnant should receive an anomaly scan at what time point?

1 - 10-12 weeks
2 - 14-16 weeks
3 - 18-20 weeks
4 - 24-26 weeks

A

3 - 18-20 weeks
- looks for malformations and uses a foetal echo to look a blood flow

49
Q

In pregnant patients with epilepsy taking anti-epileptic drugs (AED), should their blood be monitored to measure plasma levels of the AED for toxicity?

A
  • no
  • healthy non-pregnancy levels are unknown so would be pointless
50
Q

Should anti-epileptic drugs (AED) be stopped in pregnancy?

A
  • no
  • try to reduce the dose
  • BUT do not stop for risk of seizure
51
Q

Although plasma levels of anti-epileptic drugs (AED) are not routinely monitored, which 2 of the following should be monitored?

1 - mental health (anxiety and depression)
2 - blood pressure
3 - risks of seizures; stress, sleep and adherence to AED
4 - blood glucose

A

1 - mental health (anxiety and depression)
3 - risks of seizures; stress, sleep and adherence to AED

  • BP and glucose may be monitored but not routinely
52
Q

is epilepsy an indication for a planned c-section?

A
  • no
  • BUT must monitor mum and foetus for signs of distress
  • Water birth should be avoided and births should be in hospital in those with epilepsy
53
Q

If a patient has a seizure during labour, what should happen?

1 - stop seizure with medication asap
2 - continue labour manually
3 - switch to c-section
4 - allow seizure to end naturally

A

1 - stop seizure with medication asap
- high risk of foetal and maternal hypoxia

  • continuous foetal monitoring is recommended following an intrapartum seizure.
54
Q

Is the risk of seizure higher during pregnancy or post-partum?

A
  • during pregnancy
  • but reduce risks of seizure including exhaustion and sleep deprivation
55
Q

Should anti-epileptic drugs (AEDs) be continued post-partum?

A
  • yes
  • to reduce risk of seizure
56
Q

Should babies be monitored post-natally in a women who has epilepsy?

A
  • yes
  • need to assess for adverse effects of (AEDs) in utero
57
Q

Should women with epilepsy be encouraged to breast feed post-partum?

A
  • yes
58
Q

All babies born to those taking enzyme­‐inducing AEDs should be offered 1 mg of intramuscular of what?

1 - vitamin K
2 - folic acid
3 - iron
4 - coagulation factor proteins

A

1 - vitamin K
- prevents hemorrhagic disease of the new-born.

59
Q

If a patient is taking anti-epileptic drugs (AEDs) which 2 forms of contraception can be offered?

1 - Copper intrauterine devices (IUD)
2 - Mirena (LNG-IUS
3 - COC
4 - Implant

A

1 - Copper intrauterine devices (IUD)
2 - Mirena (LNG-IUS

  • not affected by enzyme inducing AEDs
60
Q

What is the preferred choice of emergency contraception?

1 - Copper intrauterine devices (IUD)
2 - Mirena (LNG-IUS
3 - COC
4 - Implant

A

1 - Copper intrauterine devices (IUD)

A. MLA Map Obstetrics and Gynaecology (29 decks)

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