Neurological Disease

Question 1

What is the prevalence of epilepsy in pregnancy

Answer 1

0.5-1%

Question 2

What is the recommended seizure free interval for pregnancy safety

Answer 2

9-12 months

Question 3

How many patients have a stable course of epilepsy during pregnancy

Answer 3

2/3
influenced by type of epilepsy
Seizure free pregnancy interval

Question 4

What is the risk of mortality in WWE compared to general population

Answer 4

10 x increase

Question 5

What is the maternal mortality rate for WWE on AED

Answer 5

60: 100 000

Question 6

What percentage of patients have increased seizure frequency

Answer 6

17%

Question 7

What percentage of patients have decreased seizure frequency

Answer 7

16%

Question 8

What is the rate of intrapartum seizures

Answer 8

3.5%

Question 9

When is the patient most at risk of seizures

Answer 9

Postpartum
- due to sleep deprivation

Question 10

When should pregnancy avoidance be recommended (7)

Answer 10

• uncontrolled seizures (esp tonic clonic)
• monthly seizures
• high dose AED
• multidrug therapy
• drug resistant epilepsy
• poor drug compliance
• poor health with other comorbid diseases

Question 11

What are the first line AED in WWE

Answer 11

Lamotrigine
Levetiracetam

Question 12

What is autonomic dysreflexia

Answer 12

Uninhibited sympathetic nervous system response.

-Seen in spinal cord lesion above T6
-Most common trigger bowel or bladder dystension
- rise in systolic BP >20-40mmhg

Question 13

How are spasms treated In patients with spinal injury

Answer 13

• baclofen intrathecal
• oxybutinin for bladder spasm

12% risk of worsening spasms in pregnancy