Obstetrics - Epilepsy in Pregnancy

Question 1

Epilepsy in Pregnancy

Causes?

Answer 1

Causes:

• Seizures caused by abnormal neuronal discharge
• Result of some form of traumatic brain injury

Three general types:

• Idiopathic - cause unknown
• Cryptogenic - cause unknown but signs it maybe linked to brain injury
• Symptomatic - cause unknown, but some cases due to VINDICATE:
  
  • V - Vascular: History of stroke
  • I - Infetion: History of Meningitis/Malaria
  • N - Neoplasms: brain tumours
  • D - Drugs: Alcohol and illicit drug use
  • I - Iatrogenic: drug withdrawal
  • C - Congenital: Fx epilepsy
  • A - Autoimmune: Vasculitis
  • T - Trauma:History of brain injury
  • E - Endocrine: Na2+Low, Ca2+Low, Low/High Glucose

Question 2

Epilepsy in Pregnancy

Signs snd Symptoms

Answer 2

Signs snd Symptoms: (Depend on the region of the brain)

Frontal Lobe: JAM

• J - Jacksonian march
• A - pAlsy (post ictal Todd’s palsy - (focal weakness in a part of the body after a seizure: subsides after 48 hours)
• M - Motor feature

Temporal Lobe: ADD FAT

• A - Aura
• D - Deja vu
• D - Delusional Behaviour
• F - Fear/panic - hippocampal involvement
• A - Automatisms
• T - Taste/smell
• Parietal and Occipital Lobe:
  
  • ​Visual and sensory disturbances

Other symptoms include:

• Partial or generalised seizures (with or without convulsions)
• Tongue biting
• Migraines
• Depression

Question 3

Epilepsy in Pregnancy

Investigations?

Answer 3

Investigations:

• Bloods - FBC, U&Es, LFTs, CRP, ESR, glucose, calcium
• Radiology - MRI
• ECG, LP, EEG

Question 4

Epilepsy in Pregnancy

Treatment (Pregnancy Specific)

Answer 4

Treatment:

• Continue anti-epilepsey treatment
• Risks of seizures outweigh harm of therapy to fetus

Conservative:

• Ensure mother is under consultant led care
• Mother to take higher dose of folic acid (5mg/day) due to increased risk of neural tube defects

Medical:

• Neonatal care: Vitamin K injections
• Carbemazepine least teratogenic of older therapies
• Sodium Valproate has strongest association with neural tube defects

Question 5

Epilepsy in Pregnancy

Complications (Pregnancy Specific)

Answer 5

Complications (pregnancy specific):

General:

• Injuries whilst having a seizure
• Depresion
• Anxiety
• Brain damage
• Sudden unexplained death in epilepsy (SUDEP)

Fetal:

• Neural tube defects
• Cleft palate (with phenytoin)
• Intrauterine growth restriction
• Development delay