Epilespy Flashcards
What are seizures
Sudden electronic disturbance in the brain excess of electrical activity sirupts the activity of neurons so the messages become mixed or halted
Most last 30ec to 2min
Generalised seizures affect al areas of the brain whereas partial seizures affect localised areas of the brain
Seizure types vary by where and how they begin in the brain Seizure
May occur after a stroke, head injury, infection
Often cause is unknown
What is epilepsy
Most common neurological disorder characterised by presence of seizures
Prevalence in general population 1-2:200 people
Prevalence in preganant population 1;200
Diagnosed by a neurologist following two or more seizures - is classified according to seizure type
Why is epilepsy relevant to childbearing
Women with epilepsy have a 10x higher risk of dying
Between 2016-2018 22 women died during or up to 1 year after pregnancy fr causes related to epilepsy
Tonic clonic
Generalised seizures resulting in sudden loss of consciousness - leading to uncontrolledfall without warning associated with fetal hypoxia and highest risk of sudep
Stiffening and bilateral jerking, followed by a post seizure state of sleepiness and confusion
Absence
Generalised seizures that result in brief blank spells and unresponsiveness followed by a rapid recovery
Modest physiological effect, worsening absence seizures increases risk of a tonic seizure
Juvenile myoclonic epilepsy
Generalised seizures that result in sudden and unpredictable jerking movements or twitches, often precedes a tonic clonic seizures
Could lead t o falls or dropping baby
Associated with sleep deprivation or when waking up
Focal
Partial seizure characterised by presence of an aura
May impair consciousness
Preseason varies but may include experiencing Deja vu making random noises unusual posture and fiddling
Risk depend on whether consciousness is lost
Associated with variable period of hypoxia and risk of SUDEP
other causes off seizures
Syncope - fainting
Ran silent is he mic attack- mini stroke
Migraine
Metabolic conditions - hypoglycaemia, hyponatremia, addisonian crisis (lack of cortisol) may causee jerking movements and collaps
Panic attacks and anxiety
Psychogenic non epileptic seizure - functional neuro disorder
Transient global amnesia - causing sudden temporary memory loss
Narcolepsy with cataplexy - cause sudden brief loss of voluntary. Muscle tone
Brain tumours
Pregnancy specific cause of seizures
In pregnancy eclampsia must be excluded
Eclampsia - seizure due to high blood presure
If a woman >20/40 presents with seizures treat as per eclampsia guidance e.g mag sulphate until a diagnosis can be made
MRI and CT scans are considered safe in pregnancy to investigate cause of seizures
Sudep
Sudden unexplained death of epilepsy
How does pregnancy afffect epilsey
2/3 of women with epilepsy will not experience a seizure in pregnancy to investigate
The longer a women has been seizure free the lower the chance of having a seizure in pregnancy
In women who were seizure free for at least 9 months to 1 year prior to pregnancy 74-92% continued to be seizure free in pregnancy
How does epilepsy affect pregnancy outcomes
Spontaneous miscarriage 1.54 x
APH 1.49x
Hyptenisve disorder 1.37 x
Fetal growth restriction 1.26 x
Preterm birth 1.16 x
Induction of labour 1.67 x`
Anti epileptic drugs
Carry a risk of tertogenicity toxic to fetus
Risk of general congenital malformation is dependant on type, number and dose
Among AEDs, Lao tribune and carbamazepine monotherpay at lower doses hav the least risk of major congenital malformation in the offspring
Neural tube defect congenital heart disorder urinary tract, skeletal abnormalities and cleft palate are associated with AED
Sodium valproate associated with neural tube defect facial cleft and hypospadias. Increase risk of congenital malformation by >4x
Phenobarbital and phenytoin are associated with cardiac malformations and phenytoin and carbamazepine with cleft palate
Women taking 2 or more AEDs have a 7x higher risk of fetal congenital malformations than women without epilepsy
Preconception care with epilepsy
AED may be changed to avoid sodium valproate pre conception and reduce doses of AED
5mg folic acid should be taken pre conception 12/40 to reduce risk of neural tube defects
Antenatal care for epilepsy
If Low risk treats as universal care
Low risk - seizure free at least 10 years and not taken AEDs for 5years or had childhood epileptic syndrome and have ow reached adulthood and are seizure and treatment free
Should hve frequent antenatal care with epilepsy care team
Safety advice on shallow bating/showering
Antenatal care for women with epilepsy
Mental health screening - alert to signs of depression, anxiety and any neuropsychiatric symptoms if taking AEDs
Risk of seizure - assessed risk factor for seizure, adherence to AED and seizure type and frequency
Serial growth scans- recommended for detection of small for gestational age babies and to plan further management for women taking AEDs
Birth planning for women with epilepsy
Diagnosis of epilepsy is not an indication of labour or c section
Unless low risk, birth on oconsultant led unit should be recommended
Decisions to se water immersion in labour should be individualised considering risk of seizures
Havin a constant birth partner is likely to make th inpatient stay safer
Intrapartum care with epilepsy
Adequate analgesia and appropriate car in labour should be provided to minise risk factors fr seizures such as insomnia stress and dehydration
Entonox, TENS and epidural/spinal id safe for women with epilepsy
Avoid pethidine for analgesia
At high risk of seizure during labour - continous fetal monitoring in labour and following an Intrapartum seizure
Avoid immersion in water
Postnatal care with epilepsy
Encourage to breastfeed even if on AED
Women at reasonable risk of seizures should not be in private room unless under continous supervision
Slightly higher risk of seizures than in pregnancy, postnatal depression, dropping or smothering baby if has a seizure
Contraception
Should be offered effective contraception to avoid unplanned pregnancy
IUD, levonorgestrel releasing intrauterine system and medroxyprogesterone acetate injection should be promoted as reliable methods of contraception that are not efffected by enzyme inducing AEDs
AEDs may affect efficacy of combined and mi ill, implant and patched
Neonatal care for babies born to women with epilepsy
Woma who have taken AEDs had higher risk of NICU admission - 1.42X
Babes born to mothers taking AED may have adverse effects such as lethargy, difficulty in feeding, excessive sedation and withdrawal symptoms with inconsolable crying
Invidulised assesment should be made for the level of neonatal monitoring required for withdrawal symptoms and for signs of toxicity - important in premature babies
Summary of principles
Pre conception care can reduce risks of fetal congenital malformations
Eclipse specialists should be involved pre conception to postnatally
Tetrogenci risks of AEDs should weighed up against risks of seizures
Avoid sodium valproate when trying to convieve or pregnant
Women with epilepsy require personalised expert care planning
