Epilepsy in Pregnancy

Question 1

What are the major risks of epilepsy during pregnancy?

Answer 1

• To mother
  
  • Increased mortality, birth complications
  • Most do not have increased seizures excpet if sleep/med deprived
• To foetus
  
  • During seizure: hypoxia/trauma
  • Inheritance of seizure predisposition
  • Anti-epileptic effects: neural tube defects, cardiac, urinary tract defects

Question 2

Which anti-epileptic drugs pose highest risl to a growing foetus?

Answer 2

• Valproate (10-20x risk of neural tube defects)
• Polytherapy
• Carbamazepine seems to be the safest overall

Question 3

What considerations might you take if counselling a woman with epilepsy pre-pregnancy?

Answer 3

• Risks (slightly increased)
• Reassurance (most uncomplicated)
• Medication (very important)
  
  • Lowest dose, fewest agents, try for not valproate
• Folate 4mg daily
• Contraception (carbamazepine, topiramate, phenytoin induce metabolism) - consider higher dose or locally-acting

Question 4

During pregnancy, what special considerations might you have in the management of a woman with epilepsy?

Answer 4

• Seizure prevention: adequate sleep and medication compliance
• Screening: aFP at 14-16 weeks, 20-week US
• Drug levels: some have increased clearance
• Vitamin K during last month of pregnancy
• Intra-partum: CTG continuous, LUSCS if increased seizures or stress-induced SE

Question 5

In the post-partum period, what considerations might you have in the management of a woman with epilepsy?

Answer 5

• Reduce antiepileptic dose back to normal in weeks after pregnancy
• Seizure prophylaxis: sleep, medication compliance
• Education: infant protection (bath with another person, change on floor)
• Breastfeeding: okay with antiepileptics