Epilepsy in pregnancy (Complete)

Question 1

How are patients with epilepsy managed pre-pregnancy?

Answer 1

Switch to monotherapy and titrate down to lowest effective dose

Stop sodium valproate and switch to less teratogenic anti-epileptics

• E.g. levetiracetam, lamotrigine

Folic acid 5mg

• Reduce risk of NTD

Question 2

What supplements must be given to pregnant woman on anti-epileptic medication?

Answer 2

Folic acid (5mg)

To minimise risk of NTDs

Question 3

Which anti-epilpeitc has the highest risk of causing congenital abnormalities and should be avoided during pregnancy?

Answer 3

Sodium valproate

Question 4

What complications are most associated with the following medications:

Sodium Valproate

Phenytoin

Answer 4

Sodium valproate: NTD

Phenytoin: Cleft palate

Question 5

Which anti-epileptics have the lowest risk of causing congenital abnormalities during pregnancy?

Answer 5

Levetiracetam

Lamotrigine

Question 6

Stopping anti-epileptic medication pre-pregnancy can be considered in which patient groups?

Answer 6

Woman with:

Low risk of unprovoked seizures

Have been fit-free for at least 2 years

Question 7

How are pregnant women with epilepsy managed during pregnancy?

Answer 7

Monitoring:

Plasma anti-epileptic drug levels (may lower during pregnancy)

Foetal anomaly and growth scans

Medicine:

Vitamin K at 36 weeks to prevent clotting disorders in newborn

Benzodiazepine: In management of acute seizure

Question 8

Why are plasma anti-epileptic levels monitored frequently during pregnancy?

Answer 8

Plasma levels can reduce due to increasing plasma volume during pregnancy.

• Hence may need to increase dose to retain theraputic range (esp the case with lamotrigine)

Question 9

Why is vitamin K given at 36 weeks in pregnant woman on anti-epileptic medications?

Answer 9

Anti-epileptics inhibit foetal clotting factor production hence are given vitamin K to prevent clotting disorders

Question 10

How are epileptic pregnant woman managed during acute episodes?

Answer 10

Benzodiazepines

N.B. If no previous Hx of seziures then assume and manage as eclampsia until proven otherwise

Question 11

How are woman with epilepsy managed post-natally?

Answer 11

Encourage to breastfeed normally if on anti-epileptic medication

Review doses to prevent post-partum toxicity as plasma levels return to normal