Women And Epilepsy

Question 1

What are the implications of bone health in epilepsy?

Answer 1

Prolonged ASM use is linked to reduced bone density, osteomalacia and osteoporosis
This is a particular issue for:
Smokers
Post menopausal women
Vitamin D insufficiency

Question 2

Which ASMs have strongest association with fractures?

Answer 2

Carbamazepine
Clonazepam
Phenobarbital
Sodium Valproate

Question 3

What are the three commonly recognised patterns of catamenial seizures?

Answer 3

Perimenstrual
Periovulatory
Luteal phase (anovulatory cycles)

Question 4

What are the hormonal cycle associations with seizures in those who ovulate?

Answer 4

Seizures are related to periods of high oestrogen in relation to progesterone

Seizures don’t occur when progesterone is high
Seizures don’t occur when both are low

Question 5

Why might ASMs interfere with contraception?

Answer 5

May reduce contraception efficacy by interfering with metabolism

Question 6

What might be reasons for reduced fertility (number of children had per woman) in epilepsy?

Answer 6

Associated morbidity (psychiatric/intellectual)
Personal choice
Lowered libido/fertility from treatment
Social factors

Question 7

What are example of poor outcome in pregnancies in PWE?

Answer 7

Major malformations
Minor malformations
Small for dates
Developmental delay
Autism spectrum disorder
Injury or SUDEP

Question 8

What are the leading causes of death in young people with epilepsy?

Answer 8

Drowning
SUDEP

Question 9

What is the risk of epilepsy in a child whose mother has epilepsy?

Answer 9

3-9%
(1-4% if father)

Question 10

What birthing complications are women on ASMs at higher risk for?

Answer 10

Induction
Caesarean section
Post-partum haemorrhage
Apgar score below 7/10
Severe pre-eclampsia
Bleeding in early pregnancy
Malformations in offspring

Question 11

What factors increase risk of foetal malformations in PWE?

Answer 11

Lower income families
Primary generalised epilepsy
Taking valproate
Previous pregnancies with FMs

Question 12

What percentage of children who were exposed to valproate in the womb have a major congenital malformation?

Answer 12

10%

Question 13

What ASM has general population level risk of foetal malformation at normal dose?

Answer 13

Lamotrigine

Question 14

What is the prevalence of major congenital malformation with high dose valproate use in pregnancy?

Answer 14

25%

Question 15

What ASMs have reduced plasma levels in pregnancy?

Answer 15

Lamotrigine
Levetiracetam
Oxcarbazapine

Question 16

Where does epilepsy fall in indirect causes of maternal death?

Answer 16

Second

Increase in gestational SUDEP has had an effect on maternal mortality