Neurology

Question 1

Epilepsy

Answer 1

Pregnancy doesn’t generally affect seizure rates of well controlled epilepsy but can with non compliance with meds and increased triggers occur or lower drug levels due to hyperemesis etc.

Effects on pregnancy
- Risk of epilepsy
- Risks status epilepticus

AEDs
- Basically all are teratogenic
- Major complications are NTD, orofacial clefts and CHD
- Fetal anticonvulsant SND: dysmorphic features, hypertelorism, hypoplastic nails and mid face.
- Lowest dose and single drug (ideally carbamazepine, lamotrigine, levetiracetam).
- Take 5mg folic acid OD
- Vit K 10-20mg OD orally last 4 weeks of pregnancy

Mg: seizure safety advice
Birth advice - continue meds, 1;1, have a plan for sleep, consider epidural, okay to BF but safety net

Question 2

Causes of seizures in pregnancy

Answer 2

Eclampsia
Epilepsy
Non epileptic seizures
Drugs
Hypoglycaemia
SOL
APLs
Electrolyte disturbance
Stroke
Infections

Question 3

Migraines and headaches

Answer 3

Migraines often improve in pregnancy but can also trigger them
Increased risk of PET
Can use beta blockers and aspirin
Sumatriptan has not evidence of harm but have minimal evidence either way.

Question 4

Multiple sclerosis

Answer 4

Less likely to relapse during pregnancy
Can increase in relapse PP

Question 5

Myasthenia gravis

Answer 5

Exacerbations can occur
Maternal abs can cause fatal fetal arthrogryposis
Mother may need instrumental delivery
Avoid specific drugs eg MgSulphate, gentamicin, salbutamol, b blockers, narcotics

Question 6

Strokes, haemorrhagic and SAH

Answer 6

MOre likely to be caused by random things eg PET, TTP, abnormal valves, endocarditis, APL, vasculitis

AVMs or berry aneurysms