Epilepsy in pregnancy (RCOG Green top guideline)

Question 1

What is the incidence of epilepsy amongst pregnant women?

Answer 1

0.5-1.0% (1/200-1/100)

Question 2

What is the significance of maternal mortality associated with epilepsy?

Answer 2

WWE have a 10 fold increase in death during pregnancy than women without Epilepsy

Question 3

What is SUDEP?

Answer 3

Sudden unexpected death in epilepsy
Definition - sudden, unexpected, non traumatic, non drowning, witnessed or non witnessed death in a patient with epilepsy with or without evidence of seizure and excluding a documented status epilepticus in which post mortem does not reveal an anatomical or toxicological cause of death

Question 4

What is the effect of tonic clonic seizure on mother and baby?

Answer 4

sudden loss of consciousness without warning - can result in fall and trauma
associated with variable periods of fetal hypoxia
this seizure type is associated with the highest risk of SUDEP

Question 5

What is the effect of absence seizure on mother and baby?

Answer 5

Adverse events due to sudden loss of concentration but physiological effects are minimal
increasing episodes of absence seizures may herald an increased risk of Tonic clonic seizure activity

Question 6

what are focal seizures and how are they defined?

Answer 6

focal seizures refer to seizure activity focussed in focal areas on the brain. Symptoms depend on which area are affected. Used to be define as complex partial and simple partial based on wether consciousness was impaired (complex) or not (simple)

Question 7

What is the impact of focal seizure on mothers and babies?

Answer 7

complex partial seizures associated with loss of consciousness carry the same risks as tonic clonic seizures

Question 8

Which conditions need to be ruled out for a first presentation of seizure in pregnancy?

Answer 8

eclampsia
cerebral venous sinus thrombosis
posterior reversible leucoencephalopathy syndrome
space occupying lesions
reversible cerebral vascoconstriction syndrome
syncope secondary to cardiac arrhythmia, aortic stenosis, carotid sinus sensitivity, vasovagal syncope and metabolic conditions (hyponatraemia, hypoglycaemia addisonian crisis)

Question 9

which AEDs are considered safest in pregnancy?

Answer 9

lamotrigine and carbamazepine
?levetiracetam (0.7/100 congenital malformation)

Question 10

what are the congenital malformations associated with sodium valproate?

Answer 10

neural tube defects
facial cleft
hypospadias

Question 11

what are the congenital malformations associated with phenytoin and phenobarbitol?

Answer 11

cardiac

Question 12

what are the congenital malformations associated with phenytoin and carbamazepine?

Answer 12

cleft palate

Question 13

what is the incidence of congenital malformation among women taking sodium valproate?

Answer 13

10/100 - 10%

Question 14

what is the baseline rate of congenital malformation?

Answer 14

2/100 (2%)

Question 15

what is the rate of congenital malformation among women taking lamotrigine?

Answer 15

2/100 2% <300mg/day
3.4/100 3.4% <400mg/day