Epilepsy Flashcards
(17 cards)
What is epilepsy
A common neurological disorder characterised by the presence of seizures, diagnosed by a neurologist following 2 or more seizures and classified by seizure type
Incidence of epilepsy
1:200
What are seizures
A sudden electrical disturbance in the brain, a sudden surge in electrical activity disrupting neuron activity so messages become mixed or halted
Most las 30s to 2 min
describe tonic clonic seizures
generalised seizures resulting in sudden loss of consciousness. stiffening and bilateral jerking followed by a post-seizure state of sleepiness and confusion
describe absence seizures
generalised seizures that result in brief blank spells and unresponsiveness, followed by rapid recovery
describe juvenile myoclonic epilepsy
generalised seizures that result in sudden and unpredictable jerking movements or twitches. often precedes a tonic clonic seizure
describe focal seizures
partial seizures characterised by the presence of an ‘aura’. may impair consciousness. but may include experiencing deja vu, making random noises,
how does pregnancy affect epilepsy
RCOG, 2016 states that 2/3 of women with epilepsy will not experience a seizure in pregnancy
how does epilepsy affect pregnancy/outcomes?
ROCG, 2016 states that women with epilepsy have an increased risk of spontaneous miscarriage
APH
hypertensive disorders
fetal growth restriction
preterm birth
IOL
describe pre-conception care for women with epilepsy
a lead clinician who manages decisions around choice and doses of anti-epileptic drugs (AEDs) based on risk to fetus and control of seizures
5mg of folic acid taken pre-conception until 12/40
(RCOG,2016)
describe AEDs and the considerations
they carry a risk of teratogenicity
lamotrigine and carbamazepine monotherapy have least risk at lower doses
sodium valporate is associated with the highest risk
women taking 2 or more AEDs have a 7x higher risk of fetal congenital malformations
(RCOG,2016)
describe additonal antenatal care for women with epilepsy
categorised as low or high risk of unprovoked seizures
low risk criteria: seizure free for 10 years and not taken any anti-epileptic drugs for 5 years
or had childhood epileptic syndrome and now are seizure and treatment free as an adult
(RCOG, 2016)
have a designated epilepsy care team
what assessments or screening do women with epilepsy have
mental health screening (depression, anxiety)
assessed for risk factors of seizures (e.g. sleep deprivation, stress, adherence to AEDs, seizure type and frequency)
serial growth scans
describe birth planning for women with epilepsy
recommendations are dependent on risk of seizures
diagnosis is not an indication for an IOL or CS
unless low risk birth recommended at a consultant-led unit
decisions to use water, should be individually assessed
birth partner is safer
intrapartum considerations
adequate analgesia to minimise risk factors for seizures
entonox, TENS and epidural/spinal are safe
avoid pethidine
at high risk of seizure during labour: continuous fetal monitoring recommended following an intrapartum seizure
avoid pool
postnatal care
taking AEDs encouraged to BF
if have reasonable risk of seizures not a private room unless under continuous supervision
contraception should be offered
neonatal care
babies born to mothers taking AEDs, may have adverse effects e.g. lethargy, difficulty feeding, excessive sedation and withdrawal symptoms with inconsolable crying
individualised assessment should be made for level of monitoring required for withdrawal symptoms and any signs of toxicity
