Epilepsy and pregnancy

1.  have a healthy pregnancy and go on to have a
healthy baby. But there is a slightly higher
risk of having a baby with:
 a birth defect
 or developmental problem

2.  The incidence of epilepsy in pregnancy is about
1 in 200
 and is the commonest,pre-existing neurological
disorder to complicate pregnancy.
 Seizures maybe generalized tonic-clonic, petit
mal (absences) or temporal lobe (complex partial
seizures).

3.  Occasionally epilepsy can present for the
first time during pregnancy.
 familial, cryptogenic account an established
diagnosis at the onset of pregnancy.
 Most cases of epilepsy are idiopathic and no
cause is found.
 Secondary epilepsy may be due to intracranial
mass, antiphospholipid syndrome, previous
surgery.

4.  Most diagnosed (known) prior to
pregnancy,
 . A fit in the second half of
pregnancy should always be
assumed to be Eclampsia by
assessment of blood pressure
urine analysis
 Other causes of fits are:
 Hypoglycemia, cerebrovascular
accident and drug or alcohol
withdrawal. CT MRI of brain ,EEG,
blood glucose, serum calcium

5.  It's difficult to predict how pregnancy will affect
epilepsy
 In most cases pregnancy does not affect the
frequency of seizures.
 25-30% ↑seizure frequency, with labour being a high
risk time for convulsion.
 the dose of anticonvulsants should be increased
after checking drug levels.
 54% no change
 And 16% decrease in seizures in pregnancy.
 Epilepsy is the common indirect cause of maternal
death and mostly due to SUDEP.

6.  Pregnancy
 Poor compliance (Fears of teratogens)
 Decreased drug levels due to nausea and
vomiting
 Decreased drug levels due to ↑volume of
distribution and ↑renal clearance
 Lack of sleep towards term and during labour
 Lack of absorption of drugs during labour

7. • No evidence adverse effects
• No increased risks of obstetric complications (IUGR, PTL,
etc)
• Status Epilepticus <1% pregnancies BUT dangerous for mum
and baby-TREAT VIGOROUSLY!
Associated with risks maternal death due to aspiration
Risk of chid developing epilepsy
• 5% if either parent has epilepsy
• 15-20% if both
Major risk is teratogenicity of drugs

8. • Major malformations are:
– Neural tube defects (esp valproate 1-2%) have highest
risk and carbamazepine (0.5-1%)
– Orofacial clefts (especially phenytoin)
– Congenital heart defects(valproate,phenytoin)
• Minor malformations (fetal anticonvulsant
syndrome)
– Dysmorphic features (V-shaped eyebrows, lowset ears,
broad nasal bridge, irregular teeth)
– Hypertelorism
– Hypoplastic nails and distal digits

9. • Risk for any one drug is 6-7%
• Risk increases with number of drugs (polypharmacy)- taking
2 or more: risk 15%
• If take phenytion, valproate AND carbamazepine, risk to
foetus is up to 50%
• Mechanism of teratogenesis though to be foliate deficiency.
• Lamotrigine, and levetiracetam are safer medicines to take in
pregnancy.

10. • Preconceptually
 The diagnosis should be reviewed by neurologistIf you're taking
anti-epileptic drugs (AEDs) and you're planning to get pregnant,
you should continue to use contraception and take your medicine
until you discuss your plans with an epilepsy specialist
(neurologist). This is because a severe seizure in pregnancy could
result in harm or injury to you or your baby.
 your doctor may want to make changes to the dose or type of
medicine you are taking.
• Control of epilepsy should be maximised prior to pregnancy
with the lowest does of most effective treatment.
• take folic acid 5mg/day from at least 12 weeks prior to
conception.
• Consider stoping all medication prior to conception if a women
has had no fits for 2 years.
• If poorly controlled review medication.
• Reduce to monotherapy where possible.

11. • Pregnancy
• Continue folic acid throughout
• Continue current drugs if well controlled ..
• Detailed fetal scan at 18-20 weeks with detailed fetal
cardiac scan at 22 weeks
• Advise shallow bath or shower (risks of drowning if fit)
• Relatives advised re: recovery position of fits
• give steroids, ↑dose if enzyme inducing drugs
(phenytoin, phenobarbitone, carbamazepine)
• All newborns have low levels of vitamin K
• Vit K 10-20mg orally from 34-36 weeks also if on enzyme
inducers due to risks of foetal Vit K deficiency and
Haemorrhagic Disease New-born

12.  Women with major convulsive seizures should
deliver in hospital.
 Most have normal deliveries
◦ LSCS only if recurrent generalised seizures in late
pregnancy/labour
 Increase in fits around time of delivery
 Seizures are best controlled with iv
benzodiazepines.
 Continue antiepileptic drugs in labour
 Offer early epidural to reduce pain/anxiety

13.  Encourage to breastfeed, sedation and
withdrawal effect must be watched .
 Information on safe handling of neonate.
 Contraception. Women taking hepatic enzyme
inducing
drugs(phenytion,carbamazpine,phenobarbito
ne)require higher does of COCP ,POP
 (DEPO-PROVERA,most reliable,should be given
After every 10 weeks.