Seizure disorder

Question 1

How do you counsel a patient with a seizure disorder about maternal risks in pregnancy?

Answer 1

Epilepsy in pregnancy is unpredictable and can have a variable frequency. Seizures are highest in the first trimester and usually reverts to the pregestational pattern at the conclusion of the pregnancy; rarely few patients experience a permanent deterioration in seizure control.

Question 2

How do you counsel a patient with a seizure disorder about obstetric risks in pregnancy?

Answer 2

The occurrence of one or more convulsions during gestation can be associated with a premature birth, increased risk of preterm delivery and reduced birth weight in male infants.

Increased risk of vaginal hemorrhage and preeclampsia.

Question 3

What are the most common complications of pregnancy in patient with seizure disorder?

Answer 3

• Hypertension
• Trauma
• Sudden death

Question 4

What is the likelihood of worsening seizures during pregnancy?

Answer 4

Patients with more than one seizure per month are more likely to have seizures in pregnancy but only 25% of patients with previously controlled seizures (less than one every 9 months) will have exacerbations in pregnancy.

Question 5

What are fetal risks of antiepileptic drug exposure?

Answer 5

• Cardiac defect
• Neural tube defect
• Cleft lip

Question 6

What are common malformations following antiepileptic exposure in utero?

Answer 6

Fetal hydantoin syndrome by phenytoin: short nose, low nasal bridge, epicanthal folds, hypertelorism, abnormal ears, wide mouth, hypoplasia of distal phalanges, short or webbed neck, low hairline.

Valproic acid: lumbar meningomyelocele

Question 7

Which antiepileptic drugs should be avoided in pregnancy?

Answer 7

Phenytoin

Valproic acid

Question 8

Which patients are candidates for high dose folic acid supplementation and what are the benefits?

Answer 8

• History of NTD in previous child
• Using antiepileptic medication
• MTHFR deficiency
• Folate deficiency

Benefit is to decrease the risk for neural tube defect.

Question 9

What are the maternal and fetal risks of seizure?

Answer 9

fetal hypoxia, acidosis, decreased placental blood flow, deceleration in fetal heart rate, maternal trauma from a convulsion, and maternal sudden unexpected death in epilepsy