Epilepsy Flashcards
(18 cards)
What is epilepsy?
The name for occasional sudden and excessive rapid and local discharges of the cerbal cortex [grey matter].
A neurological condition in which seizures recur, usually spontaneously
What is an epileptic seizure?
A paroxysmal stereotyped, disturbance of consciousness, behaviour, emotion, motor function, perception or sensation (singly or in combination) that results from cortical discharges.
What are the 2 main classifications of seizures?
Focal and generalised
What are focal onset seizures?
Varied presentation according to area of brain affected. Aware or impaired awareness. May spread- focal to bilateral tonic- clonic.
What are generalised seizures?
Awareness impaired from the onset, but could be breif- e.g. absences, myoclonic, atonic, generalised tonic clonic
What accidents and injuries can occur during seizures?
Burns/scalds
Lacerations
Dental injuries
Head trauma
Dislocation/ fractures
What are the psychosocial and psychiatric co-morbidity of epilepsy?
Depression/ anxiety
Psychosis
Neurodevelopmental disorders
quality of life
Stigma- social identity
Under employment
Cognition and memory
What are ways to live well living with epilepsy?
Identify seizure triggers. Adequate sleep
Regular meds
Stress management
Monitor and detect seizures
Safety in the home and outside
Driving restrictions
Seizure management plans
Encourage peer support
Optimise understanding of epilepsy.
What does the MBBRACE-UK, 2023 state about epilepsy in pregnancy?
Is the most common neurological disease in pregnancy
SUDEP is the leading cause of death for women with epilepsy during or up to a year after pregnancy.
How can we learn from neurological complications? (MBRRACE-UK, 2023)
-17 women died from causes related to epilepsy
-14 of whom died from SUDEP
- Similar rates from 2016-18, enar double rate from 2013-15
- This represents the period during which guidance on prescribing valproate for women and girls changes
-Most common theme in report is adherence to medication
-Regard nocturnal seizures as a ‘red flag’
Risk factors for seizures in preg?
Not taking meds as prescribed
dereasing blood levels of antiepileptic medications
-Feeling tired/ not sleeping well
-stress
Hormone changes
Water ad sodium retention
?missing meals
?caffeine
?essential oils
What are the maternal implications of seizures in pregnancy?
In 15-30% of women seizures may increase in pregnancy
Trauma from falls or burns
Anxiety, stress and depression
Memory loss
Status epilepticus
Sudden unexpected death in epilepsy
What are the fetal implications of seizures in pregnancy?
Congenital malformation of birth defects
-In the general population, there is a 2% to 3% occurrence of congenital malformations that cannot
always be predicted or prevented. In women with epilepsy, the risk is doubled to about 4% to 6%, but
overall remains low
* Risks to the developing fetus may be greater when more than one type of medication is used and
with a higher dose of medication
* Previous pregnancy or family history of a congenital malformation raises the risk during the current
pregnancy. Genetic counselling is needed in this circumstance.
* The most common malformations include cleft lip and clef palate. Cardiac and urogenital defects also
occur. Research is ongoing concerning the risks for developmental delays.
Fetal bradycardia
Increased risk of premature labour
Miscarriages
What is the management of pre conception care for a women with epilepsy?
Accurate pre-pregnancy information provision/ counselling
* Pregnancy discussed at routine appointments (women of childbearing age)
* Maximise control with lowest dose of medication - avoid polytherapy if
possible
* ?Change from valproate (neural tube closes at gestational day 26)
* ?Women who have been seizure free for >2 years may wish to discontinue
medication, particularly pre-conceptually and until after 1st trimester
* Lower risk of recurrent seizures if normal EEG, onset in childhood, seizure
control with one drug
* Folic acid 5 mg daily
* Genetic counselling referral
* WWE should be reassured that most mothers have normal healthy babies
and the risk of congenital malformations is low if they are not exposed to
anti-seizure medication in the periconception period
What is the management if care in pregnancy?
Accurate information giving
* Obstetric and Neurology multidisciplinary care - particularly if had
seizures in the year preceding conception
* Consider medication change - the lowest possible dose of seizure
medication that will control seizures is recommended. Being on a
single drug will decrease the risk of birth defects and result in fewer
drug interactions, fewer side effects, and improve compliance.
* Women may stop anti-seizure medication abruptly - need to counsel
restarting (particularly after 1st trimester)
* Anti-seizure medication levels should be checked throughout the
pregnancy
* The levels of anti-seizure medications decline in pregnancy
(particularly lamotrigine and carbamezepine), levels need checking
and possibly dose increasing
*Folic acid 5 mg daily until at least the end of 1st
trimester
* Vit D and calcium supplements
* All WWE should be offered a detailed ultrasound in
line with the National Health Service Fetal Anomaly
Screening Programme standards
* Nuchal translucency 11-13w and detailed ultrasound
18-22w by obstetrician
* Monitor growth - risk of IUGR
* General guide is seizure frequency
Management of intrapartum care for women with epilepsy>
*Risk of seizures increase in labour due to ?pain, stress,
exhaustion, sleep deprivation, hyperventilation and
dehydration - ?Epidural
* Continue anti-seizure medications
* ’There is no role for routine antepartum fetal surveillance
with CTG in WWE taking anti-seizure medications’ BUT
’continuous fetal monitoring is recommended in women at
high risk of a seizure in labour, and following an
intrapartum seizure.’ (RCOG, 2016)
* Pethidine should be used with caution in WWE for
analgesia in labour. Diamorphine should be used in
preference to pethidine.
*If seizures do not self-limit in labour - O², IV
loraxepam, rectal/IV diazepam
* CS only indicated if recurrent generalised seizures
in late pregnancy or labour
* Active management 3rd stage - risk of PPH (30-
50% increase)
* ?Avoid FBS if possible - (neonatal bleeding
complications)
What is the management of care postnatally for women with epilepsy?
*Examination of neonate - congenital
malformation and/or CNS depression
* Baby 1mg/0.1ml Vitamin K IM
* Encourage BF - anti-seizure medications
secreted in breastmilk but dose
significantly lower than that received in
utero. Also helps with withdrawal
symptoms.
* Avoid lamotrigine if BF
* If the anti-seizure medication dose was
increased in pregnancy, it should be
reviewed within 10 days of birth to avoid
postpartum toxicity/ exacerbated side
effects
*Minimize risk to baby of a maternal seizure - bath in shallow water,
change on the floor
* WWE should be screened for depression in the puerperium. Mothers
should be informed about the symptoms and provided with contact
details for any assistance.
(RCOG, 2016)
