Flashcards in Neurology Deck (18):
Brand name: Phenytoin
Brand name: Carbamazepine
Brand name: Valproic acid
Brand name: Levetiracetam
General therapeutic recommendations for treatment of epilepsy in pregnancy
Smallest effective dose, monotherapy preferableFolate supplementation of 4 mg daily
History to document in the epileptic patient
Aura - present or absentSeizure description by eyewitness, including durationPostictal phase - description, durationExacerbating factorsBirth history, esp if seizure onset was neonatal or early childhoodHistory of febrile convulsions, CNS infections, or head trauma w/ LOCFamily history
Fetal complications of epilepsy
Fetal lossPerinatal deathCongenital malformations (4-8%, or twice baseline risk)Low birth weightPrematurityDevelopmental delayChildhood epilepsy
Preconception counseling of the epileptic patient
There is a small risk of having a child with a malformation because of the sz disorder or the drugs used in its treatment. This risk is probably about double that for the nonepileptic patient (4-8%, compared with 2-3% for the general population), but there is still more than 90% chance that she will have a normal child. Preconception folic acid (4 mg) may be considered to reduce the risk of major congenital malformations.
Preconception counseling: when can an anticonvulsant be stopped, and when should the patient attempt conception
Consider neuro consultation regarding tapering off AEDs if the patient has been seizure free for > 2 years and has a nl EEG. The patient should be observed for 6-12 months off AED before attempting conception.
Seizure freedom for at least __ months before pregnancy is associated with a high likelihood of remaining seizure-free during pregnancy
Risk of epilepsy in offspring
Prenatal care of the epileptic patient
Folic acid 4 mg/dayAnatomic US at 11-13w to identify severe defectsAFP at 15-18w gestation for NTDsTargeted US at 16-20wFetal echo at 22w+/- growth US at 32wNeonates should receive 1 mg IM Vit K at birth
Which anticonvulsants should have levels monitored during pregnancy?
Anticonvulsants that interfere with oral contraceptives
Enzyme-inducing AEDS:PhenytoinPhenobarbitalCarbemazepineTopiramate (>200 mg/day)Primidone
Drugs that may interfere with absorption of anticonvulsants
Folic acid may lower plasma phenytoin levelAntacidsAntihistamines
Does prenatal vitamin K in women with epilepsy reduce the risk of newborn hemorrhagic complications?
Evidence is inadequate to determine
Postpartum considerations for mothers with epilepsy
Do not bathe child while home aloneAvoid stair climbing while carrying the babyPortable changing bad on floor should be usedAvoid using front or back carrierWomen taking enzyme-inducing anticonvulsants who desire OCPs should take one w/ >50 mcg of ethinyl estradiol