Epilepsy in Pregnancy PDF

# Epilepsy in Pregnancy ## Definition Epilepsy is a medical disorder characterized by recurrent unprovoked seizures resulting from excessive neuronal discharge. ## Prevalence * 0.5-1% of women of childbearing age. * Most common serious neurological condition in pregnancy. * MR 10x higher than t...

# Epilepsy in Pregnancy ## Definition Epilepsy is a medical disorder characterized by recurrent unprovoked seizures resulting from excessive neuronal discharge. ## Prevalence * 0.5-1% of women of childbearing age. * Most common serious neurological condition in pregnancy. * MR 10x higher than the general population. ## Things that Lead to Deterioration of Epilepsy During Pregnancy * Poor epilepsy control before pregnancy * Multiple seizures per month * High-dose and drug resistance * Polytherapy rather than monotherapy * Triggers factors during pregnancy like nausea and vomiting, sleep deprivation and labor. * Poor drug compliance ## When to Avoid (Postponed) Pregnancy * Uncontrolled seizures * High-dose of antiepileptic drugs * Polytherapy * Drug resistance * Poor general health problems (comorbidity) * Other medical health problems ## Management MDT = Multiple Disciplinary Team ### Preconception Counseling * Effect of disease on pregnancy or pregnancy on disease * Maternal risk * Fetal risk * How to minimize risk * When to avoid pregnancy * Review medication and dose adjustments ### Antenatal Care * Mother monitoring * Counsel the patient about maternal and fetal risks if not counseled before (unplanned pregnancy). * Never recommend to stop or change antiepileptic drugs abruptly * Encourage the patient for drug compliance * Fetal monitoring * 4 scans: 1st trimester scan, viability scan, anomaly scan with echo and growth scan. ### Role of Vitamin K * Maternal: Oral vitamin K (not recommended) to prevent postpartum hemorrhage and hemorrhage disease of the newborn. * Neonate: IM vitamin K recommended to prevent hemorrhage of the newborn. ### Mode of Delivery Most patients have uncomplicated vaginal delivery labor. (IOL, CIS = Obstetrical indication) ### Intrapartum Care * MDT (consultant lead unit, one to one care) * When: Hospital * Where: At term (vaginal delivery unless obstetrical indication). * Maternal care * Continuous fetal monitoring * Adequate hydration * Analgesia * Continuous antiepileptic drug * Avoid stress, sleep deprivation and pethidine (increased risk of seizure) * Risk of seizure: 1% (status epilepticus). * If seizure occurs: Benzodiazepines ### Management of Status Epilepticus: * ABC + lateral tilt * Benzodiazepines: * Lorazepam 0.1mg/kg * Diazepam 10mg IV/PR (if not controlled) * Phenytoin * Tocolytics * Expedite delivery if the fetal heart rate does not recover * Risk of recurrent seizure ### Neonatal Care Risk of neonatal withdrawal syndrome ### Postpartum Care * Risk of seizures is higher in the postpartum period. * Continue antiepileptic drugs: If the dose was increased in pregnancy, review and decrease within 10 days to avoid toxicity * Avoid seizure triggers: * Support hydration * Minimize pain and stress. * Avoid sleep deprivation * Screen for depression 30% * Encourage breast feeding ### Safety Measures: * Nursing on the floor * Shallow baby bath (not alone) * Lay baby down when aura occurs. * Avoid sleep deprivation ## Contraception * Copper IUD: Category 1 - Not affected by enzyme - inducing drugs * Depo Provera: Category 1 - Not affected by enzyme - inducing drugs * Combined Oral Contraceptives (COC) and Progestogen Only Pills (POP): Category 3 - Efficacy is decreased if on enzyme - inducing drugs * Patch, Ring and Implant: Category 1 - Not affected by enzyme - inducing drugs * **All contraceptive methods are offered if not on enzyme-inducing drugs. * **Enzyme-inducing drugs: * Carbamazepine * Phenytoin * Phenobarbital * Primidone * **Non enzyme-inducing drugs:** * Sodium valproate * Lamotrigine * Gabapentine * Levetiracetam