Seizure Disorders in Preg

Question 1

Risks of seizure disorder in Pregnancy?

Answer 1

• Prematuiry
• IUFD
• FGR
• Congenital malformation (NTD) - decreased folate absorption
• Pre E w/ increased maternal mortality

Question 2

First line treatment for seizure disorder in pregnancy?

Answer 2

Ideally monotherapy

Lamotrigine (drug level decreases by 90% in preg)

Levetiracetam (drug level decreases by 40-60% in preg)

Question 3

Monitoring drug levels of anti-seizure medications?

Answer 3

Decreased protein binding (increased drug levels)

Increased renal clearance, hepatic metabolism, and plasma volume = decreased total drug levels

Check every 4 weeks, then at 6 weeks postpartum

Monitor “free” levels (biologically active fraction)

Question 4

Fetal Hydantoin Syndrome?

Answer 4

Pre and postnatal growth restriction
Microcephaly
Neurodevelopment issues
Craniofacial anomalies

Question 5

Management of seizure disorders in Pregnancy?

Answer 5

• Good pre-conception control
• Try to get on single agent therapy
• Increase folic acid supplementation (4 mg/day), lowers risks but not down to baseline
• Accurate gestational dating (due to risk FGR)
• Screening for NTD and other congenital anomalies (AFP, Nuchal translucency)
• Monitor drug levels
• Monitor fetal growth