Epilepsy In Pregnancy

Question 1

How is diagnosis in pregnancy made

Answer 1

Bp, Blood glucose, serum calcium
Urine, Uric acid
Platelet count
Clotting profile
EEG, MRI,

Question 2

What are the types of epilepsy

Answer 2

• primary generalized E = tonic clonic, myclonic and absent
• partial or focal seizures = with or without loss of consciousness
• temporal lobe seizures

Question 3

What are the secondary reasons that cause epilepsy

Answer 3

• previous surgery to the cerebral hemispheres
• intracranial mass
• APS → anti phospholipid syndrome

Question 4

How does epilepsy affect pregnant

Answer 4

fetus: hypoxia, fetal bradycardia, increased risk of congenital abnormalities, Dysmorphic features → hypertelorism, hypoplasia of midface and hypo plastic nails. Major → orofacial cleft, congenital heart defect

Question 5

How to minimize congenital abnormalities

Answer 5

Folio acid 5mg daily prior to conception until end of 1st trimester
Reduce risk of anti-epileptic drugs related problems

Question 6

How should oestrogen be prescribed

Answer 6

Prescriber with ethanol estradiol ≥50ug

Question 7

How to manage status epilepticus

Answer 7

Lateral semi-prone position
Secure airway and resuscitate
Assess cardio reps function
Give O2
Diazepam 10-20mg rectally
Midozolam 10 mg buccally
Establish IVI access
Give dextrose 50%
Give thiamine 100 mg IVI or IMI
Lorazepam 0.lmg/kg or diazepam

Question 8

What is the loading IVI for status epilepticus

Answer 8

• Valproate 15-20 mg/kg over 5 min or
• phenytoin 15-20mgkg over 30 min
. Phenobarbital 20mg at 100 mg/min