Epilepsy in pregnancy

Question 1

What to do with seizures during pregnancy?

Answer 1

Seizures (1st presentation) in 2nd half which arent atributed to epilepsy - Mx as eclampsia

other causes-
epilepsy, encephilitis/menigitis, eclampsia. SOL, CVA, malaria/toxoplasmosis, TTP, alcohol withdraw

treat each as their own disease/see other cards

if not caused by disease/ preexisiting - see Mx card (but aim monotherapy lowest dose with lamotrigine/Carbazepine)

Question 2

Mx of epilepsy in pregnancy

Answer 2

seizures need to be controlled with MINIMUM possible dose of anticonvulsants (lamotrigine/Carbazepine) -monotherapy if possible

pre-preg councelling-
adjust medication -monotherapy if posssible
Compliance!
folic acid at all TIMES
Vitk last months
risk of congenital malformation

+ measures done at delivery (epidural, etc)
invite register to UK epilepsy and preg register

Question 3

Complications of epilepsy in pregnancy/ epilepsy MX in pregnancy

Answer 3

Overall Risk of uncontrolled epilepsy (hypoxia) outweight risk of medication
AED are known to cause 2-3x increase in congenital abnormalities ( neural, facial, cardiac, other) -detected in scans
3-4% of cengenital defect

Folic acid +vit K in last month

Medication -
Sodium valporate -neural tube defects-no
Phenytoin- cleft palate- NO
Lamotrigine - lowest risk - good
Carbamezipine- less teratogenic - good