Women and epilepsy Flashcards
How is bone health relevant to epilepsy?
-Long term ASM including, but not exclusively those with enzyme inducing effects, may be associated with reduction in bone density
-Management should include being proactive about optimizing bone health in the long term
What can long term ASM use indicate for bone health?
long-term treatment with some antiseizure medications (such as carbamazepine, phenytoin, primidone and sodium valproate) is associated with decreased bone mineral density and increased risk of osteomalacia.
-vitamin D supplementation should be considered for at-risk patients who receive long-term treatment with primidone, phenytoin, carbamazepine, phenobarbital, or sodium valproate’
What are catamenial seizures?
-linked to a woman’s menstrual cycle and related hormone levels in the body
-Catamenial epilepsy refers to the cyclic exacerbation of seizures in relation to the menstrual cycle.
What are the three commonly recognised patterns in catamenial seizures?
-perimenstrual (C1: Day -3 to +3),
-peri-ovulatory (C2: Day 10 to -13)
-Entire luteal phase in anovulatory cycles (C3: Day 10 to 3).
How can pregnancy be protected for women with epilepsy?
-Planned pregnancy essential
-Folic acid preconception
-Anti-seizure medication reviewed/adjusted before conception to minimize teratogenic risk while keeping the mother (and later the unborn child safe)
-Pregnancy and fetus monitored to maximize safety including, monitoring anti-seizure medication levels
-Small risk of seizures during labour
-Advice for postpartum
What are poor outcomes for pregnant women with epilepsy?
-Major malformations
- Minor malformations
- Small for dates
- Developmental delay/ Autistic Spectrum Disorder
- Injury or SUDEP
What are aspects to consider for women with epilepsy regarding pregnancy?
-Risk to offspring of inheriting either the epilepsy or related underlying condition
-Risk of pregnancy complications – how much are they increased?
-Risk of teratogenicity (minor/major/neurodevelopmental) from Anti-Seizure meds
-Control of the epilepsy during pregnancy? Risk to the mother (from seizures or status during or after pregnancy or from pregnancy complication) & thus risk to fetus
-Ability of mother/family to look after baby if mother has uncontrolled epilepsy (+ co-morbidity) including physical risk to baby if mother has uncontrolled seizures
What are the relevant dimension in decision making?
-Medical
-Social
-Ethical
-Moral
-Religious: e.g. if potential termination is an option
What are some broad estimates of risk of inheriting epilepsy
-General population risk ~ 1% by young adulthood
-Risk of epilepsy is higher in offspring
of a mother with epilepsy 2.9%-8.7%
compared to a father 1.0%-3.6%
for a daughter compared to a son
for idiopathic generalised epilepsy compared to focal
-For a parent with onset of epilepsy BEFORE age 20 years, offspring risk of epilepsy = 2.3%-6%
-Compared to a parent with onset of epilepsy > age of 20 years, offspring risk of epilepsy = 1%-3.6%
What did the Australian registry show regarding use of valproate during pregnancy?
1558 AED (valproate) exposed pregnancies;
-Significantly increased chance of foetal malformations (FM) in women:
-from families on lower incomes,
-with primary generalised epilepsies,
-taking valproate (VPA)
-with previous pregnancies resulting in FMs
What can be done to reduce risk of ASMs during pregnancy?
Adjust/ or change medication where there is a history of a previous malformation without compromising the safety of the mother
What is SUDEP?
Sudden Unexpected Death in Epilepsy
What are some of the indirect causes of maternal death?
-Cardiac disease remains the largest single cause of indirect maternal deaths.
-Neurological causes (epilepsy and
stroke) are the second most common indirect cause of maternal death, and the third commonest cause of death
overall.
-There has been a statistically significant increase in maternal mortality due to Sudden Unexpected Death
in Epilepsy (SUDEP)
