seizures in pregnancy

Question 1

what is the drug of choice for seizure control in pregnancy?

Answer 1

lamotrigine

Question 2

what is the ttx range of lamotrigine?

Answer 2

2.5-15 mcg/ml

has the most decrease in serum levels in pregnancy

Question 3

what are therapuetic levels of carbamazepine (tegretol), phenytoin (dilantin), phenobarbital?

Answer 3

5-10 carbamazepine (tegretol), 10-20 phenytoin (dilantin), 20-40 phenobarbital

all mg/L

Question 4

what are epilepsy or treatment of epilepsy’s risk on pregnancy?

Answer 4

iufd, iugr, preeclampsia

Question 5

what special considerations are with anticonvulsants?

Answer 5

• increased risk of NTD; give 4 mg not 0.4 mg/day
• decreased vitamin K; give neonate vit K after delivery
• decrease vitamin d
• variable level (phenytoin, phenobarbital, carbamazepine) -> free level goes up due to decrease in albumin but total levels go down due to increase in renal clearance
• potential fetal effect of ASD/VSD

Question 6

valproate/depakote? okay in pregnancy? what risks?

Answer 6

not okay- NTD defects, developmental delay (possible decrease in IQ at age 3)

Question 7

trimethadione (tridione)? okay in pregnancy? what risks?

Answer 7

not okay- cranio-facial defect, cardiac

Question 8

hydantoin (dilantin)? okay in pregnancy? what risks?

Answer 8

yes

hydantoin syndrome- iugr/postnatal growth restriction, microcephaly, mental retardation, phalangeal hypoplasia

Question 9

concepts of seizure management in pregnancy

Answer 9

• gain good control prior to pregnancy
• try to get to single agent
• lamotrigine is drug of choice
• serial monitoring due to decreasing levels
• assess for NTD, give 4 mg folic acid daily
• assess for other congenital anomalies

Question 10

keppra - teratogenic?

Answer 10

no