Epilepsy Flashcards
(25 cards)
What’s a seizure?
Sudden electrical disturbance in the brain that disrupts neurone activity
What’s the difference between generalised and partial seizures?
GS: affects all areas of the brain
PS: affects localised areas
What is epilepsy?
-most common neurological disorder
-presence of seizures
Epilepsy prevelance:
General population 1-2:200
Pregnant population 1:200
Risk of dying with epilepsy
10X
22 women died during or 1 year post pregnancy due to epilepsy
What is SUDEP?
sudden unexpected death in epilepsy
Risks with tonic clonic seizures
-sudden unconsciousness
-uncontrolled falls and jerking
-associated with fetal hypoxia
-highest risk of SUDEP
Risk with absence seizures
-loss of awareness and response
- worsening absence seizures can lead to tonic clonic
Risks with juvenile myoclonic epilepsy
-can precede tonic clonic
-unexpected jerking
-risk of falling or dropping baby
Risk of focal seizures
-can lose consciousness
-can result in unusual posture, stiffness
-risk of SUDEP and hypoxia
General epilepsy risk
-injury
-drowning
-higher rate of depression and anxiety
RCOG, 2016
What to do if a woman >20/40 presents with seizures?
Eclampsia must be excluded so treat her as per eclampsia guideline with magnesium sulphate
MRI and CT scans to investigate
How does pregnancy affect epilepsy?
-2/3 will not have a seizure
-longer seizure free, less likely to have seizure during pregnancy
Pregnancy outcomes with epilepsy
-increased risk of miscarriages (1.5X)
- IOL (1.6X)
-APH (1.4X)
What are anti-epileptic drugs (AED)?
Teratogens (toxic to fetus)
Common malformations with AED:
-neural tube defects
-CHD
-skeletal abnormalities
Risks of sodium valproate:
-increases risk of congenital malformations by 4X
Pre-conception care with epilepsy
-obstetric led
-discuss AED type and dosage
-never stop abruptly taking AED
-5mg folic acid preconception till 12/40
Define low risk with epilepsy
-seizure free for at least 10 years
-not taken AED for 5 years
-had childhood epilepsy but is now treatment and seizure free
Antenatal care for epileptic women
-if meets low risk epilepsy criteria than treat as low risk
- should have designated epileptic team
-advice on how to safely bathe, etc
- frequent growth scans and epilepsy assessments
-mental health screening
Birth planning for epileptic women
-review seizure risk with water birth
-epilepsy isn’t an CS indication
-D/S recommended
-have birth parented present to make inpatient stay safer
Intrapartum care for women with epilepsy
-adequate analgesia to reduce seizure risk such as stress and insomnia
-CTG
-avoid water immersion if high risk for seizure
Postnatal care for women with epilepsy
-encouraged to breastfeed as AEDS can not pass through breastmilk
-if at risk of seizures, should not be in side room
-slight higher risk of smothering or injuring themselves or baby is seizure risk
Contraception for women with epilepsy
-contraception should be offered to avoid unplanned pregnancy
-AEDs can affect efficacy of contraception
