Epilepsy in Pregnancy

Question 1

define epilepsy

Answer 1

hypersynchronous hyperexcitability of groups of neurons, imbalance bw inhibition vs excitation

Question 2

list 3 types of classifications

Answer 2

focal onset: confined to one area of the brain
motor: tonic-clonic
non-motor: absence

Question 3

compare tonic and clonic phases

Answer 3

tonic: strong contraction of whole musculature, cry/groan, loss of awareness, stop resps
clonic: violent, synchronous jerks, slow recovery to consciousness, confusion

Question 4

describe absence seizures

Answer 4

typically in childhood, sudden loss of awareness, intact control of muscles, usually 1-15s but recurring often, symptoms include fluttering eyes, staring into distance

Question 5

describe cause of absence

Answer 5

abnormality in T-type calcium channels leading to characteristic ECG with 3 spikes per second, occurring in hypothalamus

Question 6

what are absence seizures treated with?

Answer 6

valproate, CCB

Question 7

what initiates a focal seizure?

Answer 7

simultaneous firing of a group of neurons in the brain, site determines symptoms

Question 8

describe genetic basis of seizures and risk associated with it

Answer 8

> 30% of epilepsies have genetic component, in close relatives of people with generalised epilepsy the risk is only 4x higher than gen pop

Question 9

describe MOA of Antiepileptic drugs

Answer 9

block hyperexcitability, sodium channels to stop impulse transmission, calcium channels responsible for NT release, strengthen GABA input and block glutamatergic input

Question 10

what are first line AE meds in pregnancy?

Answer 10

lamotrigine and levetiracetam

Question 11

what AE has high risk on fetus?

Answer 11

valproate, assoc ADHD, impaired psychomotor dev, reduced verbal IQ

Question 12

describe tx of eclampsia

Answer 12

prevention and control of seizures with mag sulf, if seizures ongoing add benzo