Pre - pregnancy counselling and management of epilepsy

Question 1

Pre- pregnancy counselling in epilepsy

Answer 1

• If not exposed to AEDs, the incidence of major congenital malformations is similar to the background risk for the general population
• If taking AEDs, the risk of major congenital malformation to the fetus is dependent on the type, number and dose of AED.
• Among AEDs, lamotrigine, and carbamazepine monotherapy at lower doses have the least risk of major congenital malformation in the offspring
• 10.7 per 100 risk with valproate
• 16.8 per 100 risk with polytherapy

Question 2

Most common major congenital malformations associated with AEDs

Answer 2

• Neural tube defects
• Congenital heart disorders
• Urinary tract abnormalities
• Skeletal abnormalities
• Cleft palate.with ; and phenytoin and
  carbamazepine with cleft palate in the fetus.

Question 3

Most common major congenital malformations associated with valproate

Answer 3

• Neural tube defects
• Facial cleft palate
• Hypospadias

Question 4

Most common major congenital malformations associated with phenobarbital and phenytoin

Answer 4

Cardiac malformations

Question 5

Most common major congenital malformations associated with phenytoin and carbamazepine

Answer 5

• Cleft palate in the fetus.

Question 6

What is the effect of pregnancy on seizures in WWE?

Answer 6

• Two-thirds will not have seizure deterioration in pregnancy.
• Pregnant women who have experienced seizures in the year prior to conception require close
  monitoring for their epilepsy.
• Women with idiopathic generalised epilepsies are more likely to remain seizure free (74%) than those with focal epilepsies (60%)