Neurological Disease Flashcards
What is the prevalence of epilepsy?
0.5% women of childbearing age
For a first seizure in pregnancy, what are the appropriate investigations?
BP, urinalysis, FBC, clotting screen, U+Es, LFTs (PET)
BSL
CT / MRI Brain
EEG
What is the effect of pregnancy on epilepsy?
For most women, no effect on seizure frequency
Those with poorly controlled epilepsy more likely to deteriorate
Highest risk of seizures postpartum
What is the effect of epilepsy on pregnancy?
No increased risk (unless seizure results in abdominal trauma)
Status epilepticus is dangerous for mother and fetus
Fetus relatively resistant to short episodes of hypoxia
What is the risk of a fetus developing epilepsy if
A) Either parent has epilepsy
B) Previously affected sibling
C) Both parents have epilepsy
A) 4-5%
B) 10%
C) 15-20%
What are the major congenital anomalies caused by anti-epileptics?
Neural tube defects
Orofacial clefts
Congenital heart defects
In epilepsy, what should be prescribed for women taking hepatic enzyme-inducing AEDs? And when?
Vitamin K
Last 4 weeks of pregnancy
Vitamin K clotting factors may be reduced
Risk of Haemorrhagic disease of the newborn is increased
When are women with epilepsy most at risk of having a seizure?
1-2% during labour
1-2% in the first 24h postpartum,
Therefore, women should not be left unattended in labour or for the first 24h postpartum
And should continue their regular AEDs in labour
When does the neural tube close?
Gestational day 26
What is relevant when considering contraception and epilepsy?
Women taking hepatic enzyme-inducing antiepileptics
Require higher doses of oestrogen to achieve adequate contraception
Same with the POP
Need double dose of ECP
Most headaches in pregnancy are due to…
Tension headache or migraine
What are the clinical features of a migraine?
Throbbing, unilateral severe headache
Prodromal symptoms: visual - transient hemianopia, aphasia, sensory symptoms
Nausea and vomiting
Photophobia or noise sensitivity
Hemiplegic migraine may rarely lead to cerebral infarction
What is the pathogenesis of tension headaches?
Muscle contraction
Often related to periods of stress
What is the pathogenesis of migraines?
Primary neurovascular disorder
Inflammatory component
Vasodilation of cerebral blood vessels, possibly related to platelet aggregation and serotonin release
What are the differential diagnoses of a headache in pregnancy?
PET Post-dural puncture headache SAH Meningitis Cerebral venous thrombosis Idiopathic (benign) intracranial hypertension Intracranial mass lesions Reversible cerebral vasoconstriction syndrome
Pre-existing migraine is associated with an increased risk of…
PET
Outside pregnancy: Stroke IHD VTE HTN Diabetes
What is the management for migraines in pregnancy?
LDA prophylaxis
Beta blockers (propranolol)
TCA: amitriptyline
What are the clinical features of Multiple Sclerosis?
Relapsing and remitting clinical course
Optic neuritis, diploid, sensory symptoms, weakness of the limbs
Variable course
What is the pathogenesis of Multiple Sclerosis?
Exact pathogenesis unknown
Multiple areas of demyelination within the brain and spinal cord
What is the effect of pregnanc on MS?y
Decrease relapse rate in 3rd trimester ? Decrease in cell mediated immunity
Neuropathic bladder: may have increased problems with UTIs
Rate of relapse increases in the first 3 months postpartum
How is a severe acute relapse of MS managed, in pregnancy?
High dose steroids
Is there any contraindication to epidural anaesthesia in MS?
No
What is the pathogenesis of Myasthenia Gravis?
IgG antibodies directed against post-synaptic antigens on the motor end plate
Block neuromuscular transmission
Causing weakness and fatigue or skeletal, but not smooth muscle
What is the effect of myasthenia Gravis on pregnancy?
Transplacental passage of antibodies
Fetal Arthrogryposis (can be fatal)
- contractures due to lack of movement
- polyhydramnios due to impaired swallowing
