This document discusses issues related to epilepsy management in women. It notes that around half of women with epilepsy are of reproductive age. Female hormones can impact seizure thresholds. Estrogen is proconvulsant while progesterone is anticonvulsant. Catamenial epilepsy refers to seizures clustering around the menstrual period. Pregnancy can alter seizure patterns and medication levels. Risks to the fetus include congenital malformations from some medications. Managing both epilepsy and pregnancy requires careful consideration of seizure control and fetal safety.
This document discusses various aspects of managing epilepsy in women. It notes that while the fundamental principles of epilepsy management are the same for men and women, managing epilepsy in women requires attention to some special considerations. These include catamenial epilepsy related to the menstrual cycle, increased risk of sexual dysfunction and reduced fertility from some antiepileptic drugs (AEDs), and increased risk of conditions like polycystic ovarian syndrome (PCOS) in women with epilepsy. It provides guidance on counseling women with epilepsy regarding contraception, pregnancy planning, and risks during pregnancy and delivery.
This document discusses issues related to women with epilepsy, including:
- About half of women with epilepsy are of reproductive age. Enzyme-inducing antiepileptic drugs can reduce the effectiveness of contraceptives.
- Catamenial epilepsy involves seizures related to the menstrual cycle. Hormonal treatments like progesterone can help control seizures.
- Epilepsy during pregnancy presents challenges of balancing seizure control and risks of medication. Risks include fetal malformations, developmental effects, and pregnancy complications. Lower-risk drugs include lamotrigine and levetiracetam. Frequent monitoring is important.
- Pregnancy can impact epilepsy through hormonal changes and drug level fluctuations requiring dose adjustments
The document discusses epileptic encephalopathy syndromes that occur in neonates, infants, and children. It describes the key features of early myoclonic encephalopathy, West syndrome, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and continuous spike-wave during sleep. The syndromes are characterized by seizures, developmental regression or impairment, and specific electrographic findings on EEG. Prognosis varies between syndromes but is often poor, with cognitive and neurological deficits. Treatment involves antiepileptic drugs, corticosteroids, ketogenic diet, or surgery in refractory cases.
Majority of women with epilepsy can have a normal pregnancy with a favorable outcome, though there are some increased risks compared to the general population. Multiple anti-epileptic drugs can interfere with birth control pills, so barrier methods are recommended. Exposure to anti-epileptic drugs during pregnancy has been linked to fetal anti-convulsant syndrome, minor and major birth defects. While no anti-epileptic drug is completely safe during pregnancy, lamotrigine appears to pose less risk of major malformations.
This document discusses several neurological disorders that can occur during pregnancy, including epilepsy, migraine, myasthenia gravis, multiple sclerosis, preeclampsia, eclampsia, and cerebral venous thrombosis. It provides classifications of pre-existing and new onset disorders. For each condition, it describes key aspects like prevalence during pregnancy, maternal and fetal effects, and management approaches both during pregnancy and delivery. The management sections emphasize the importance of multidisciplinary care and balancing treatment of the underlying condition against risks to the mother and fetus.
This document summarizes key information about antiepileptic medications during pregnancy. It discusses that approximately 1% of the general population has seizures, which can be partial or generalized. While untreated epilepsy is not associated with increased malformations, antiepileptic drugs do increase risks. Common medications like carbamazepine, phenytoin, and valproic acid are associated with risks like fetal malformations, growth issues, and behavioral problems. Proper management during pregnancy aims to control seizures at lowest effective drug doses and includes monitoring drug levels, ultrasounds, and vitamin supplementation.
1. Epilepsy in women can be affected by hormonal changes during menarche, the menstrual cycle, pregnancy, and menopause. Seizure frequency may increase or decrease depending on the phase of the menstrual cycle or pregnancy.
2. Certain antiepileptic drugs can interact with hormonal contraceptives, increasing the risk of contraceptive failure. Changes in weight are also a common side effect of many antiepileptic medications in women.
3. Pregnancy poses risks to both mother and fetus related to seizures and effects of antiepileptic drugs, including an increased risk of malformations, developmental issues, preterm birth, and low birth weight. Careful preconception
This document discusses early infantile epileptic encephalopathies (EIEEs), a group of severe epilepsy syndromes that occur in infants under 3 months of age. The three main syndromes discussed are Ohtahara syndrome, early myoclonic encephalopathy (EME), and malignant migrating partial seizures of infancy. They are characterized by frequent seizures, severe developmental impairment, and burst suppression on EEG. Prognosis is generally poor with survivors left with severe cognitive deficits. Underlying causes include genetic mutations and structural brain abnormalities. Treatment options have limited success.
This document discusses various aspects of managing epilepsy in women. It notes that while the fundamental principles of epilepsy management are the same for men and women, managing epilepsy in women requires attention to some special considerations. These include catamenial epilepsy related to the menstrual cycle, increased risk of sexual dysfunction and reduced fertility from some antiepileptic drugs (AEDs), and increased risk of conditions like polycystic ovarian syndrome (PCOS) in women with epilepsy. It provides guidance on counseling women with epilepsy regarding contraception, pregnancy planning, and risks during pregnancy and delivery.
This document discusses issues related to women with epilepsy, including:
- About half of women with epilepsy are of reproductive age. Enzyme-inducing antiepileptic drugs can reduce the effectiveness of contraceptives.
- Catamenial epilepsy involves seizures related to the menstrual cycle. Hormonal treatments like progesterone can help control seizures.
- Epilepsy during pregnancy presents challenges of balancing seizure control and risks of medication. Risks include fetal malformations, developmental effects, and pregnancy complications. Lower-risk drugs include lamotrigine and levetiracetam. Frequent monitoring is important.
- Pregnancy can impact epilepsy through hormonal changes and drug level fluctuations requiring dose adjustments
The document discusses epileptic encephalopathy syndromes that occur in neonates, infants, and children. It describes the key features of early myoclonic encephalopathy, West syndrome, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and continuous spike-wave during sleep. The syndromes are characterized by seizures, developmental regression or impairment, and specific electrographic findings on EEG. Prognosis varies between syndromes but is often poor, with cognitive and neurological deficits. Treatment involves antiepileptic drugs, corticosteroids, ketogenic diet, or surgery in refractory cases.
Majority of women with epilepsy can have a normal pregnancy with a favorable outcome, though there are some increased risks compared to the general population. Multiple anti-epileptic drugs can interfere with birth control pills, so barrier methods are recommended. Exposure to anti-epileptic drugs during pregnancy has been linked to fetal anti-convulsant syndrome, minor and major birth defects. While no anti-epileptic drug is completely safe during pregnancy, lamotrigine appears to pose less risk of major malformations.
This document discusses several neurological disorders that can occur during pregnancy, including epilepsy, migraine, myasthenia gravis, multiple sclerosis, preeclampsia, eclampsia, and cerebral venous thrombosis. It provides classifications of pre-existing and new onset disorders. For each condition, it describes key aspects like prevalence during pregnancy, maternal and fetal effects, and management approaches both during pregnancy and delivery. The management sections emphasize the importance of multidisciplinary care and balancing treatment of the underlying condition against risks to the mother and fetus.
This document summarizes key information about antiepileptic medications during pregnancy. It discusses that approximately 1% of the general population has seizures, which can be partial or generalized. While untreated epilepsy is not associated with increased malformations, antiepileptic drugs do increase risks. Common medications like carbamazepine, phenytoin, and valproic acid are associated with risks like fetal malformations, growth issues, and behavioral problems. Proper management during pregnancy aims to control seizures at lowest effective drug doses and includes monitoring drug levels, ultrasounds, and vitamin supplementation.
1. Epilepsy in women can be affected by hormonal changes during menarche, the menstrual cycle, pregnancy, and menopause. Seizure frequency may increase or decrease depending on the phase of the menstrual cycle or pregnancy.
2. Certain antiepileptic drugs can interact with hormonal contraceptives, increasing the risk of contraceptive failure. Changes in weight are also a common side effect of many antiepileptic medications in women.
3. Pregnancy poses risks to both mother and fetus related to seizures and effects of antiepileptic drugs, including an increased risk of malformations, developmental issues, preterm birth, and low birth weight. Careful preconception
This document discusses early infantile epileptic encephalopathies (EIEEs), a group of severe epilepsy syndromes that occur in infants under 3 months of age. The three main syndromes discussed are Ohtahara syndrome, early myoclonic encephalopathy (EME), and malignant migrating partial seizures of infancy. They are characterized by frequent seizures, severe developmental impairment, and burst suppression on EEG. Prognosis is generally poor with survivors left with severe cognitive deficits. Underlying causes include genetic mutations and structural brain abnormalities. Treatment options have limited success.
* A 23-year-old pregnant woman with epilepsy was admitted to the hospital at 40 weeks of pregnancy. She has a history of epilepsy since 2012 and has been taking carbamazepine and clonazepam to control her seizures.
* Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Pregnancy can impact seizure frequency in women with epilepsy, though most experience no change or a decrease. Antiepileptic drugs also carry risks of birth defects, developmental issues, or pregnancy complications.
* Careful prenatal care including screening, continued medication, folic acid, and delivery in a hospital equipped to treat seizures is recommended to support healthy outcomes for both mother and baby.
This document discusses epilepsy and pregnancy. Some key points:
- Epilepsy affects 0.5% of women of childbearing age and is the most common neurological disorder complicating pregnancy.
- Seizure frequency may increase, decrease or remain unchanged during pregnancy, depending on the individual. The risk of seizures is highest around delivery.
- Antiepileptic medications used to treat epilepsy can cause birth defects, especially sodium valproate which has been linked to neural tube defects. The risk increases with multiple medications and higher valproate doses.
- Women with epilepsy need folic acid, careful monitoring of seizure frequency and medication levels during pregnancy, and fetal screening for birth defects. Managing epilepsy treatment aims to control
Partial complex epilepsy is characterized by focal seizures that impair consciousness. It is most commonly caused by temporal lobe epilepsy but can arise from other brain regions. Diagnosis involves obtaining a detailed history, physical exam, EEG, and MRI brain imaging. Treatment includes antiepileptic medications and potentially surgery for drug-resistant cases. Surgical options include temporal lobectomy for temporal lobe epilepsy, which can cure seizures in over 50% of carefully selected patients. Prognosis depends on seizure frequency and underlying etiology.
Women with Epilepsy: Role of newer anti-seizure drugsPramod Krishnan
Women with Epilepsy often have unique considerations when managing their condition. Hormonal fluctuations can impact seizure frequency, and some anti-seizure medications are associated with higher risks of birth defects, cognitive issues in offspring, menstrual irregularities, and bone health issues. Levetiracetam appears to carry lower risks during pregnancy and for bone health compared to other anti-seizure drugs like valproate, phenobarbital, and phenytoin, which should generally be avoided. Careful planning and medication management is important when considering pregnancy or contraception for women with epilepsy.
1. Epilepsy in pregnancy requires careful management to reduce risks to both the mother and baby. Anti-epileptic drugs increase the risk of fetal anomalies and developmental issues, while discontinuing medication increases the risk of seizures.
2. Close monitoring is needed during pregnancy and delivery to control seizures and minimize risks. Regional analgesia and continuing anti-epileptic drugs are recommended.
3. The postpartum period also carries higher risk of seizures, so safety precautions and supportive care are important to implement. Breastfeeding is generally encouraged while continuing appropriate anti-epileptic drug treatment.
Periodic Lateralized Epileptiform Discharges (PLEDs) are repeating waveforms seen on EEG that occur at regular intervals and are localized to one hemisphere. They are commonly seen after acute cortical injuries like stroke and infections. PLEDs are classified based on their pattern and presence of additional rhythmic discharges. They indicate unstable brain physiology resulting from seizures, injury or metabolic disturbances. While not strictly ictal, PLEDs are associated with increased risk of clinical seizures. Prognosis depends on the underlying cause, with acute severe strokes having the worst outcomes. Treatment involves antiepileptic drugs mainly if clinical seizures are present.
management of neurological disorders in pregnancyNeurologyKota
This document summarizes the management of several neurological disorders in pregnancy, including epilepsy, multiple sclerosis, myasthenia gravis, and cerebrovascular disease. For epilepsy, it discusses risks of antiepileptic drugs to the fetus, challenges in balancing seizure control and medication risks, and approaches to preconception counseling, treatment during pregnancy, and postpartum management. For multiple sclerosis, it addresses disease-modifying therapies, breastfeeding considerations, and treating relapses. For myasthenia gravis, it outlines prepregnancy planning, treatment options during pregnancy including acetylcholinesterase inhibitors and immunosuppressants, labor and delivery guidance, and postpartum breastfeeding recommendations. For cerebro
This document discusses different types of autoimmune encephalitis. It categorizes autoimmune encephalitis as either paraneoplastic, non-paraneoplastic, or associated with vasculitis. Within non-paraneoplastic autoimmune encephalitis, several specific types are described that are associated with antibodies against receptors like NMDA, GABA, AMPA, and LGI1. Clinical features, pathogenesis, diagnosis and treatment approaches are summarized for some of the major types like anti-NMDA receptor encephalitis. Long term management involves immunosuppression with steroids and other agents to prevent relapse, though neurologic sequelae may still occur in some patients.
Dementia with Lewy bodies (DLB) is diagnosed based on progressive cognitive decline along with core clinical features such as fluctuating cognition, visual hallucinations, REM sleep behavior disorder, and spontaneous parkinsonism. Biomarkers like reduced dopamine transporter uptake and abnormal MIBG scans provide supportive evidence. DLB is managed through a multidisciplinary approach including accurate diagnosis, symptom identification and intervention, education of caregivers, and a team-based care plan. Treatment focuses on cholinesterase inhibitors for cognitive and neuropsychiatric symptoms, though antiparkinsonian drugs require caution due to increased risk of psychosis.
This document provides information on genetic epilepsy and juvenile myoclonic epilepsy. It defines epilepsy and describes its various classifications including idiopathic, symptomatic and cryptogenic epilepsy. Juvenile myoclonic epilepsy is discussed in detail, including its genetics, clinical manifestations such as myoclonic jerks and absence seizures, diagnosis through EEG findings, and treatment options involving anti-seizure medications. Circumstances for genetic testing in epilepsy cases are outlined.
This document discusses epilepsy and pregnancy. It begins with an introduction that covers the incidence of epilepsy in women of childbearing age and classifications of seizures. It then discusses how pregnancy can affect epilepsy and how epilepsy can affect pregnancy, including risks to the mother and fetus. It covers the teratogenic risks of antiepileptic drugs and their mechanisms. The management section discusses diagnosis, differential diagnosis, and considerations in the prenatal, antenatal, intrapartum, and postpartum periods. Fetal outcomes are also addressed.
Epileptic encephalopathies are a group of epileptic disorders that cause cognitive and behavioral impairments beyond what would be expected from seizures alone. They typically begin early in life and are characterized by frequent seizures and abnormal EEG patterns. Common types include early myoclonic encephalopathy, Ohtahara syndrome, West syndrome, Dravet syndrome, and Lennox-Gastaut syndrome. These disorders can cause developmental delays, intellectual disabilities, and in some cases early death. Treatment aims to control seizures, though many types are highly treatment resistant.
1. PLEDs (Periodic Lateralized Epileptiform Discharges) are a pattern seen on EEG characterized by periodic discharges that are lateralized to one hemisphere.
2. They are commonly seen in conditions involving acute brain injury or inflammation such as stroke, encephalitis, tumors, or hypoxic ischemic encephalopathy.
3. PLEDs are associated with a risk of seizures but generally indicate an unstable brain state that will improve over time as the underlying condition resolves. Prognosis depends on the specific cause.
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
The document discusses epilepsy and pregnancy, outlining several key points:
1. The aims of treatment for epileptic women who are pregnant are to control seizures, prevent obstetric complications, and ensure adequate neonatal outcomes.
2. Babies born to epileptic mothers face higher risks of seizures, developmental issues, and birth defects ranging from 4-8% compared to 2-3% in the general population.
3. Folic acid supplementation and monotherapy with antiepileptic drugs can help reduce risks, but all drugs studied still show major malformation rates of at least 6%. Close monitoring is important for both mother and baby.
The document discusses frontal lobe epilepsy, including its anatomy and functions, aetiology, diagnosis, and treatment. It covers the different classifications of frontal lobe seizures based on their functional anatomy and manifestations. Some key seizure types mentioned are Rolandic epilepsy, which involves characteristic "Jacksonian march" seizures, and ventromedial and dorsolateral prefrontal seizures, which present with different behavioral and autonomic symptoms. Evaluation involves neuroimaging like MRI and EEG to localize the seizure focus. Treatment options include medications, surgery, diet, and management of impairments.
This document discusses epileptic encephalopathies, which are a group of heterogeneous brain disorders occurring during brain development where epileptiform activity contributes to cognitive and behavioral regression beyond the underlying pathology. It defines and classifies several early-onset epileptic encephalopathy syndromes according to age of onset such as Ohtahara syndrome, early myoclonic encephalopathy, West syndrome, Dravet syndrome, Lennox-Gastaut syndrome, and myoclonic-astatic epilepsy. It provides details on clinical presentation, EEG features, causes, and treatment approaches for each condition.
Dravet syndrome is a severe form of epilepsy caused by a genetic mutation of the SCN1A sodium channel. It begins in infancy with prolonged seizures and later involves various seizure types including myoclonic seizures. Diagnosis involves clinical evaluation, EEG showing diffuse slowing, and genetic testing. Treatment aims to control seizures and involves first line medications like clobazam and valproate as well as cannabidiol. The condition carries significant risks of developmental delays, morbidity, and mortality.
Psychogenic nonepileptic seizures (PNES) are not caused by neurological dysfunction but are psychologically determined. Common psychiatric conditions associated with PNES include depression, anxiety, somatoform disorder, PTSD, dissociative disorder, and various personality disorders. A history of sexual or physical abuse is reported in one-third to half of PNES patients. PNES episodes typically last longer than 2 minutes, involve eyes being closed and variable motor movements rather than stereotyped behaviors seen in epilepsy. Diagnosis involves distinguishing PNES from epileptic seizures based on clinical features during and after episodes.
Use of prescribed psychotropics during pregnancyRiaz Marakkar
This document discusses the use of prescribed psychotropic medications during pregnancy. It begins by providing context on global pharmaceutical consumption patterns. It then discusses the prevalence of maternal mental health problems and the need for more research on risks of psychotropic medication use during pregnancy. The document categorizes medications from A to X based on risks in pregnancy. It discusses specific risks of various antidepressants, mood stabilizers, antipsychotics and other drug classes. It also addresses considerations for pharmacotherapy in pregnancy, balancing severity of the condition with risks. The document concludes by discussing risks and guidelines regarding breastfeeding while taking psychiatric medications.
* A 23-year-old pregnant woman with epilepsy was admitted to the hospital at 40 weeks of pregnancy. She has a history of epilepsy since 2012 and has been taking carbamazepine and clonazepam to control her seizures.
* Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Pregnancy can impact seizure frequency in women with epilepsy, though most experience no change or a decrease. Antiepileptic drugs also carry risks of birth defects, developmental issues, or pregnancy complications.
* Careful prenatal care including screening, continued medication, folic acid, and delivery in a hospital equipped to treat seizures is recommended to support healthy outcomes for both mother and baby.
This document discusses epilepsy and pregnancy. Some key points:
- Epilepsy affects 0.5% of women of childbearing age and is the most common neurological disorder complicating pregnancy.
- Seizure frequency may increase, decrease or remain unchanged during pregnancy, depending on the individual. The risk of seizures is highest around delivery.
- Antiepileptic medications used to treat epilepsy can cause birth defects, especially sodium valproate which has been linked to neural tube defects. The risk increases with multiple medications and higher valproate doses.
- Women with epilepsy need folic acid, careful monitoring of seizure frequency and medication levels during pregnancy, and fetal screening for birth defects. Managing epilepsy treatment aims to control
Partial complex epilepsy is characterized by focal seizures that impair consciousness. It is most commonly caused by temporal lobe epilepsy but can arise from other brain regions. Diagnosis involves obtaining a detailed history, physical exam, EEG, and MRI brain imaging. Treatment includes antiepileptic medications and potentially surgery for drug-resistant cases. Surgical options include temporal lobectomy for temporal lobe epilepsy, which can cure seizures in over 50% of carefully selected patients. Prognosis depends on seizure frequency and underlying etiology.
Women with Epilepsy: Role of newer anti-seizure drugsPramod Krishnan
Women with Epilepsy often have unique considerations when managing their condition. Hormonal fluctuations can impact seizure frequency, and some anti-seizure medications are associated with higher risks of birth defects, cognitive issues in offspring, menstrual irregularities, and bone health issues. Levetiracetam appears to carry lower risks during pregnancy and for bone health compared to other anti-seizure drugs like valproate, phenobarbital, and phenytoin, which should generally be avoided. Careful planning and medication management is important when considering pregnancy or contraception for women with epilepsy.
1. Epilepsy in pregnancy requires careful management to reduce risks to both the mother and baby. Anti-epileptic drugs increase the risk of fetal anomalies and developmental issues, while discontinuing medication increases the risk of seizures.
2. Close monitoring is needed during pregnancy and delivery to control seizures and minimize risks. Regional analgesia and continuing anti-epileptic drugs are recommended.
3. The postpartum period also carries higher risk of seizures, so safety precautions and supportive care are important to implement. Breastfeeding is generally encouraged while continuing appropriate anti-epileptic drug treatment.
Periodic Lateralized Epileptiform Discharges (PLEDs) are repeating waveforms seen on EEG that occur at regular intervals and are localized to one hemisphere. They are commonly seen after acute cortical injuries like stroke and infections. PLEDs are classified based on their pattern and presence of additional rhythmic discharges. They indicate unstable brain physiology resulting from seizures, injury or metabolic disturbances. While not strictly ictal, PLEDs are associated with increased risk of clinical seizures. Prognosis depends on the underlying cause, with acute severe strokes having the worst outcomes. Treatment involves antiepileptic drugs mainly if clinical seizures are present.
management of neurological disorders in pregnancyNeurologyKota
This document summarizes the management of several neurological disorders in pregnancy, including epilepsy, multiple sclerosis, myasthenia gravis, and cerebrovascular disease. For epilepsy, it discusses risks of antiepileptic drugs to the fetus, challenges in balancing seizure control and medication risks, and approaches to preconception counseling, treatment during pregnancy, and postpartum management. For multiple sclerosis, it addresses disease-modifying therapies, breastfeeding considerations, and treating relapses. For myasthenia gravis, it outlines prepregnancy planning, treatment options during pregnancy including acetylcholinesterase inhibitors and immunosuppressants, labor and delivery guidance, and postpartum breastfeeding recommendations. For cerebro
This document discusses different types of autoimmune encephalitis. It categorizes autoimmune encephalitis as either paraneoplastic, non-paraneoplastic, or associated with vasculitis. Within non-paraneoplastic autoimmune encephalitis, several specific types are described that are associated with antibodies against receptors like NMDA, GABA, AMPA, and LGI1. Clinical features, pathogenesis, diagnosis and treatment approaches are summarized for some of the major types like anti-NMDA receptor encephalitis. Long term management involves immunosuppression with steroids and other agents to prevent relapse, though neurologic sequelae may still occur in some patients.
Dementia with Lewy bodies (DLB) is diagnosed based on progressive cognitive decline along with core clinical features such as fluctuating cognition, visual hallucinations, REM sleep behavior disorder, and spontaneous parkinsonism. Biomarkers like reduced dopamine transporter uptake and abnormal MIBG scans provide supportive evidence. DLB is managed through a multidisciplinary approach including accurate diagnosis, symptom identification and intervention, education of caregivers, and a team-based care plan. Treatment focuses on cholinesterase inhibitors for cognitive and neuropsychiatric symptoms, though antiparkinsonian drugs require caution due to increased risk of psychosis.
This document provides information on genetic epilepsy and juvenile myoclonic epilepsy. It defines epilepsy and describes its various classifications including idiopathic, symptomatic and cryptogenic epilepsy. Juvenile myoclonic epilepsy is discussed in detail, including its genetics, clinical manifestations such as myoclonic jerks and absence seizures, diagnosis through EEG findings, and treatment options involving anti-seizure medications. Circumstances for genetic testing in epilepsy cases are outlined.
This document discusses epilepsy and pregnancy. It begins with an introduction that covers the incidence of epilepsy in women of childbearing age and classifications of seizures. It then discusses how pregnancy can affect epilepsy and how epilepsy can affect pregnancy, including risks to the mother and fetus. It covers the teratogenic risks of antiepileptic drugs and their mechanisms. The management section discusses diagnosis, differential diagnosis, and considerations in the prenatal, antenatal, intrapartum, and postpartum periods. Fetal outcomes are also addressed.
Epileptic encephalopathies are a group of epileptic disorders that cause cognitive and behavioral impairments beyond what would be expected from seizures alone. They typically begin early in life and are characterized by frequent seizures and abnormal EEG patterns. Common types include early myoclonic encephalopathy, Ohtahara syndrome, West syndrome, Dravet syndrome, and Lennox-Gastaut syndrome. These disorders can cause developmental delays, intellectual disabilities, and in some cases early death. Treatment aims to control seizures, though many types are highly treatment resistant.
1. PLEDs (Periodic Lateralized Epileptiform Discharges) are a pattern seen on EEG characterized by periodic discharges that are lateralized to one hemisphere.
2. They are commonly seen in conditions involving acute brain injury or inflammation such as stroke, encephalitis, tumors, or hypoxic ischemic encephalopathy.
3. PLEDs are associated with a risk of seizures but generally indicate an unstable brain state that will improve over time as the underlying condition resolves. Prognosis depends on the specific cause.
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
The document discusses epilepsy and pregnancy, outlining several key points:
1. The aims of treatment for epileptic women who are pregnant are to control seizures, prevent obstetric complications, and ensure adequate neonatal outcomes.
2. Babies born to epileptic mothers face higher risks of seizures, developmental issues, and birth defects ranging from 4-8% compared to 2-3% in the general population.
3. Folic acid supplementation and monotherapy with antiepileptic drugs can help reduce risks, but all drugs studied still show major malformation rates of at least 6%. Close monitoring is important for both mother and baby.
The document discusses frontal lobe epilepsy, including its anatomy and functions, aetiology, diagnosis, and treatment. It covers the different classifications of frontal lobe seizures based on their functional anatomy and manifestations. Some key seizure types mentioned are Rolandic epilepsy, which involves characteristic "Jacksonian march" seizures, and ventromedial and dorsolateral prefrontal seizures, which present with different behavioral and autonomic symptoms. Evaluation involves neuroimaging like MRI and EEG to localize the seizure focus. Treatment options include medications, surgery, diet, and management of impairments.
This document discusses epileptic encephalopathies, which are a group of heterogeneous brain disorders occurring during brain development where epileptiform activity contributes to cognitive and behavioral regression beyond the underlying pathology. It defines and classifies several early-onset epileptic encephalopathy syndromes according to age of onset such as Ohtahara syndrome, early myoclonic encephalopathy, West syndrome, Dravet syndrome, Lennox-Gastaut syndrome, and myoclonic-astatic epilepsy. It provides details on clinical presentation, EEG features, causes, and treatment approaches for each condition.
Dravet syndrome is a severe form of epilepsy caused by a genetic mutation of the SCN1A sodium channel. It begins in infancy with prolonged seizures and later involves various seizure types including myoclonic seizures. Diagnosis involves clinical evaluation, EEG showing diffuse slowing, and genetic testing. Treatment aims to control seizures and involves first line medications like clobazam and valproate as well as cannabidiol. The condition carries significant risks of developmental delays, morbidity, and mortality.
Psychogenic nonepileptic seizures (PNES) are not caused by neurological dysfunction but are psychologically determined. Common psychiatric conditions associated with PNES include depression, anxiety, somatoform disorder, PTSD, dissociative disorder, and various personality disorders. A history of sexual or physical abuse is reported in one-third to half of PNES patients. PNES episodes typically last longer than 2 minutes, involve eyes being closed and variable motor movements rather than stereotyped behaviors seen in epilepsy. Diagnosis involves distinguishing PNES from epileptic seizures based on clinical features during and after episodes.
Use of prescribed psychotropics during pregnancyRiaz Marakkar
This document discusses the use of prescribed psychotropic medications during pregnancy. It begins by providing context on global pharmaceutical consumption patterns. It then discusses the prevalence of maternal mental health problems and the need for more research on risks of psychotropic medication use during pregnancy. The document categorizes medications from A to X based on risks in pregnancy. It discusses specific risks of various antidepressants, mood stabilizers, antipsychotics and other drug classes. It also addresses considerations for pharmacotherapy in pregnancy, balancing severity of the condition with risks. The document concludes by discussing risks and guidelines regarding breastfeeding while taking psychiatric medications.
This document discusses the effects of epilepsy and anti-epileptic drug (AED) use on reproductive health and pregnancy outcomes. It notes that women with epilepsy have an increased risk of gestational hypertension, preterm delivery, fetal malformations, and low birthweight infants. During pregnancy, AED levels may decrease due to changes in metabolism and clearance, increasing seizure risk. Close monitoring of drug levels and seizures is recommended during pregnancy to adjust dosages as needed. Folic acid supplementation is also advised to reduce the risk of neural tube defects.
Trauma is a leading cause of non-obstetric death in pregnancy and can complicate 6-7% of pregnancies. The most common causes of trauma during pregnancy are motor vehicle collisions, assaults, falls, and domestic violence. Managing trauma in pregnancy requires a multidisciplinary approach and care of both the mother and fetus. The priorities are resuscitation of the mother to also resuscitate the fetus, assessment of fetal well-being, and treatment of maternal injuries while minimizing risks to the fetus. Diagnostic imaging such as ultrasound and CT scans can be used judiciously as long as radiation exposure is minimized. Timely delivery via c-section may be needed if the mother or fetus are critically unstable.
The document discusses several neurological disorders that can occur during pregnancy, including seizure disorders and neuropathies. For seizure disorders, it covers the pathophysiology, importance of preconception counseling to ensure seizures are controlled, potential pregnancy complications like preeclampsia and preterm delivery, risk of embryofetal malformations from anticonvulsant drugs including cardiac and neural tube defects, and management approaches like monotherapy with the lowest effective dose. For neuropathies, it examines Bell's palsy and carpal tunnel syndrome, providing details on their pathophysiology, incidence, symptoms, and treatment including corticosteroids and splinting.
This document provides an overview of neurology topics related to pregnancy, including diagnostic imaging, pre-existing neurological diseases like epilepsy and myasthenia gravis, and their management during pregnancy. It discusses safety of different imaging modalities in pregnancy, effects of pregnancy on diseases and their treatment, risks to the mother and fetus, and recommendations to minimize risks. Medication management is addressed for various conditions, focusing on maintaining seizure control and myasthenia gravis remission while minimizing fetal risks.
This document provides guidelines for screening and managing women at risk for blood clots. It discusses how estrogen increases thrombosis risk and how this risk is further increased by age, contraceptive use, hormone replacement therapy, pregnancy, and hypercoagulable states. It recommends screening for hypercoagulable states only in certain situations and treating with low molecular weight heparin during pregnancy, postpartum, and for women with a history of clots. The duration of treatment depends on the thrombotic risk factors present.
Lecture 6. Endocrine diseases and pregnancy (1).pdftotohaamzaa
The document discusses several key points regarding endocrine diseases and pregnancy:
1) The thyroid gland has important functions in maintaining pregnancy, including increased T4 requirements by the mother and fetus' dependence on maternal hormones in early pregnancy.
2) Physiological changes include suppression of TSH and increases in thyroid hormones and binding proteins, maintaining normal free levels.
3) Iodine deficiency is a major cause of thyroid issues worldwide, and intake of 250 μg/day is recommended for pregnant women.
4) Hypothyroidism occurs in 1% of pregnancies and requires thyroxine treatment. Thyrotoxicosis also requires medication management to prevent complications.
This document discusses hyperthyroidism during pregnancy. It covers the incidence, types, causes, clinical features, laboratory diagnosis, effects of pregnancy on thyrotoxicosis and vice versa, and management. The most common cause is Graves' disease. Left untreated, thyrotoxicosis can cause complications for both mother and fetus like miscarriage. Treatment involves antithyroid medications like PTU or carbimazole to maintain euthyroidism while minimizing risk to the fetus. Surgery and radioactive iodine are generally avoided during pregnancy. Careful monitoring is needed to balance control of the mother's condition and fetal well-being.
Management of INFERTILITY in PCOD Difficulties & SolutionsMade Easy , Dr....Lifecare Centre
This document discusses the management of infertility in patients with polycystic ovarian syndrome (PCOS). It begins by outlining the types of patients seen, including those with anovulatory infertility, obesity, and menstrual irregularities. The challenges of PCOS treatment in women aged 20-40 are then presented, including concerns about infertility, pregnancy loss, and risks during pregnancy like preeclampsia and gestational diabetes. Treatment options for infertility in PCOS patients are then discussed, including clomiphene citrate, gonadotropins, laparoscopic ovarian drilling, and metformin. Protocols for ovarian stimulation with clomiphene citrate and gonadotropins are also presented.
This document discusses the obstetric management of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS). It provides information on:
1) The increased risks of adverse pregnancy outcomes for patients with SLE/APLS including preeclampsia, intrauterine growth restriction, and preterm birth.
2) Medication management during pregnancy focusing on continuing hydroxychloroquine and tapering corticosteroids due to their safety profiles. Other immunosuppressants are generally avoided due to risks.
3) Increased monitoring is recommended during pregnancy for SLE/APLS patients including frequent visits and testing to monitor for disease flares and complications. Delivery planning focuses
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic cholestasis of pregnancy (ICP) is characterized by Pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
Imapct of Thyroid disorder on Reproduction-DrSelim.pdfShahjadaSelim1
Thyroid disorders are the commonest endocrine disorders in all people, though less talked about.
Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy but more common than Diabetes in the community.
Female related infertility accounted for 37% and combined male and female factors for 35% of the causes of infertility.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Introduction
• Epilepsy is a highly prevalent neurological disorder ≈1%
of the population.
• About half of the women with epilepsy are in the
reproductive age group of 15–49 years.
• 0.5% of women of child-bearing age
• Commonest chronic neurological disorder to complicate
pregnancy.
3. • National Institute for Health and Care Excellence (NICE)
has also identified women in the reproductive age group
to have specific and unique problems in managing their
epilepsy.
4. ROLE OF HORMONES IN EPILEPSY
• Female hormones change the excitability of brain and
alter the threshold for seizures.
• There are times in a woman’s life when change in
hormone levels and hormone balance happen:
during her periods
during pregnancy
throughout the menopause
5. HORMONES IN EPILEPSY
ESTROGEN
• PROCONVULSANT
• REDUCES INHIBITION AT
GABA -A RECEPTOR
• ALTERS mRNA FOR GAD AND
INHIBITS GABA SYNTHESIS
•
• Woolley CS, Schwartzkroin PA. Epilepsia 1998;39(suppl 8):S2-S8
PROGESTERONE
• ANTICONVULSANT
• INCREASESINHIBITION AT
GABA -A RECEPTOR
• ATTENUATES EXCITATION
OF GLUTAMATE IN
HIPPOCAMPUS
• ALTERS mRNA FOR GAD
AND INCREASES GABA
SYNTHESIS.
6.
7. EFFECT OF AEDS ON WEIGHT
• Drug Weight gain
• Valproate >50%
• Carbamazepine 15-25%
• Gabapentin 15%
• Lamotrigine No
• Levetiracetam No
• Topiramate Loss in 45-85%
8. PCOD
• More prevalent in epileptics
41% GTCS
26% Focal Seizures
• Valproic acid May contribute to PCOS (43%)
• Rx - Clomiphene
9. Menarche
• Few seizure appear during this age like JME, JAE in
25%.
• Few childhood seizure change pattern.
• Sporadic seizure may become cyclical.
• Benign rolandic ,Absence seizure may remit.
10. Menarche
• Pitutary gonadotrophins (FSH AND LH)- Increased
• Ovarian steroids (estrogen and progesterone) increase in
overall concentration.
11. CATAMENIAL EPILEPSY
• SEIZURES that tends to cluster in relation to menstrual
periods.
HIGH LEVELS OF ESTROGEN
LOW LEVELS OF PROGESTERONE
FLUID AND ELECTROLYTE IMBALANCE
PSYCHOLOGICAL STRESS
DECREASE IN LEVELS OF AEDS
12. CATAMENIAL EPILEPSY
• 10-70% of epilepsy in women.
• Type-I (Perimenstrual)
• Type-II (Periovulatory)
• Type-III (Second half of MC in anovlulatory cycle )
• CLOBAZAM has shown to be most effective (60-80%).
13. MENOPAUSE & EPILEPSY
• Early menopause in some.
• Increased estrogen /progesterone increases seizure
frequency.
15. FERTILITY IN WWE
• Women with epilepsy have approximately 15% fewer
children than expected.
• Reasons –
Social effects of epilepsy
-Menstrual irregularity-
-1 of 3 women with epilepsy,
-Oligo and polymenorrhea (1/3)
-Anovulatory MC(1/3) .
-Effect of some antiepileptic medications on the ovaries
-Effect of seizures/AED on reproductive hormones.
16. • Age, lower education, and polytherapy with antiepileptic
medications also risk factors (Sukumaran et al., 2010)
17. CHALLENGES:pregnency in epileptic
female
• Pregnancy is a state where pharmacokinetic changes are
more pronounced and more rapid than during any other
period of life.
• Risks with uncontrolled seizures during pregnancy need
to be balanced against potential teratogenic effects of
antiepileptic drugs .
18. • Maternal mortality is ten-times higher in women with
epilepsy than in those without.
• Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia2014;
55:e72–74
19. EFFECT OF EPILEPSY ON
PREGNANCY
Spontaneous miscarriage
Antepartum haemorrhage
Postpartum haemorrhage
Hypertensive disorders (preeclampsia ,eclampsia )
Induction of labour
20. Caesarean section ( increased)
Any preterm birth before 37 weeks of gestation
Fetal growth restriction
WWE had increased risk of preterm delivery
• Maternal mortality risk is increased more than 10-fold
compared to women without epilepsy
• (MacDonald SC, Bateman BT, McElrath TF, Hernandez-Diaz S. Mortality and Morbidity
DuringDelivery Hospitalization Among Pregnant Women With Epilepsy in the United
States. JAMA Neurol.2015;72(9):981-8.)
21. Pregnancy Registries
• To assess pregnancy outcomes in women with epilepsy,
different groups established epilepsy and pregnancy
registries in the late 1990s
• Prospectively enrol large numbers of pregnancies with
exposure to antiepileptic drugs
22.
23. • UK registry enrolls pregnancies from the United Kingdom
and Ireland
• NAAPR enrolls pregnancies mainly from the United
States and Canada.
• EURAP registry-Europe, Asia, Oceania, Australia, and
South America.
• Australian registry
24. • Seizures had occurred during pregnancy in-
79.2% of pregnancies with < 1 year of pre-pregnancy
seizure freedom
23% of those with at least 1 year’s freedom
20.5% with 2 years’ freedom
19% with 3 years’ freedom
17.5% with 4 years’ freedom and in 17.7% with 5 or
more years seizure-freedom
25. Women with epilepsy versus those without (2 809 984
pregnancies) had-
increased odds of spontaneous miscarriage (OR
1·54, 95% CI 1·02–2·32; I²=67%)
antepartum haemorrhage (1·49, 1·01–2·20; I²=37%)
post-partum haemorrhage (1·29, 1·13–1·49;
I²=41%)
hypertensive disorders (1·37, 1·21–1·55; I²=23%)
induction of labour (1·67, 1·31–2·11; I²=64%)
caesarean section (1·40, 1·23–1·58; I²=66%), any
preterm birth (<37 weeks of gestation; 1·16, 1·01–
1·34; I²=64%), and fetal growth restriction (1·26,
1·20–1·33; I²=1%).
26. Seizure in pregnancy
• More than 70 % of patients pass through the pregnancies
without changes in seizure frequency
• Two-third remain complete seizure-free
• Minor proportion of WWE experience reduced seizure
frequency
• Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and
treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry.
Epilepsia.2013;54(9):1621-7
27. • One-quarter to one-third of pregnant have increased
seizure frequency or seizure recurrence during the course
of their pregnancy
• Status epilepticus occurs in 1 – 2% of pregnancies in
women with epilepsy
28. • WWE will experience a seizure during labour or within the
first 24 hours after delivery.
• Nine-fold increase in seizures compared to the risk during
pregnancy in general.
29. Seizure deterioration in pregnancy
• Women who have been seizure-free up until the
pregnancy breakthrough seizures –
1 trimester:- poor compliance
• Labour and delivery is the period with the highest risk of
seizures
• Risk of having a GTCS during labour is approximately 1 –
2%
• and when all types of seizures on average 5%.
30. • Excessive nausea
• Vomiting
• Non-compliance especially during the first trimester
• Hormonal changes, sleep deprivation, anxiety, and
psychosocial stress provoked by the pregnancy may also
influence negatively on seizure susceptibility
31. Risk factors for deteriorated seizure
control
• Each pregnancy tends to have its own seizure pattern,
which means that even if a serious worsening of seizures
occurs during one pregnancy, the woman does not need
to be discouraged if she wants to become pregnant
again(NICE 2012 GUIDELINES).
32. Highest risk of seizure worsening
Patients with focal epilepsy
Use of polytherapy
Specific AEDs (lamotrigine and oxcarbazepine)
• Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al.
Seizure control and treatment changes in pregnancy: observations from the
EURAP epilepsy pregnancy registry. Epilepsia.2013;54(9):1621-7
33. • Pregnancy can alter the pharmacokinetics of most AEDs
and lead to increased clearance of the drugs
• Fall in the plasma concentration is the most common
explanation for seizure deterioration
• Lamotrigine Oxcarbazepine and Levetiracetam have
increased clearance during pregnancy and require close
monitoring throughout pregnancy.
• Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in
pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology.
2008;70
34. Treatment during pregnancy
Cochrane Database of Systematic Reviews 2004, Issue 3
It is advisable for women to continue medication during
pregnancy using monotherapy at the lowest dose required to
achieve seizure control.
Polytherapy would seem best avoided where possible.
35. Recommendations for delivery
• Vaginal delivery is recommended.
• Caesarean delivery can be considered in cases of high
risk of GTCS (1%-3%), or if prolonged or frequent CPS
make it difficult for the woman to labour.
• Epidural anaesthesia can be administered
• Using prostaglandins is not contraindicated.
36. Recommendations for delivery
• Plasma levels should be checked 2 to 3 weeks after
childbirth. If doses were changed during pregnancy, they
should be adjusted again
• Advice on sleep hygiene
Epilepsia, 50(Suppl. 1):7–23, 2009
37. INDICATIONS OF CAESAREAN
SECTION
• Frequent seizures greatly impair cooperation in
forthcoming labour and delivery.
• Generalised seizure during labour.
• Refractory status epilepticus in the third trimester.
• Sveberg L, Svalheim S, Taubøll E. The impact of seizures on pregnancy and delivery. Seizure 2015;28:35–8.-
Dubovický M. Neurobehavioral manifestations of developmental impairment of the brain. Interdiscip Toxicol
2010;3:59–67
40. Neonatal outcomes
• Children of WWE have an increased risk of-
Born with low Apgar scores
Low birth weight (<2500 g)
Small for gestational age
Major congenital malformations,
Intrauterine growth retardation
long-term cognitive and behavioral dysfunction of the
offspring
41. • Relative impacts of different seizure types are difficult to
determine-
SPS have minimal effect on the fetus.
CPS may leads to injuries due to L.O.C.
GTCS are feared the most-injury, alterations in
electrolytes, blood pressure and oxygenation.
45. • Kerala Registry of Epilepsy and Pregnancy had been
prospectively evaluating the reproductive issues of
women with epilepsy since April 1998 to 2013.
46.
47.
48.
49.
50. Terato genecity of AED
• Most serious teratogenic effects occur during the first 2.5
months of gestation.
• Changing medication before or during the first trimester is
most useful.
• The neural tube closes between 3 and 4 weeks.
• Cleft lip and palate occur with exposure before 5 and 10
weeks, respectively
• Congenital heart disease occurs before 6 weeks.
51. • Valproate doses over 800 mg/day - highly teratogenic.
• Lamotrigine has been associated with low teratogenic
risks.
52. NON-TERATOGENIC EFFECTS OF AEDS
ON CHILDREN EXPOSED , IN UTERO
• There is a longer term risk to the cognitive and
behavioural development of the child exposed in utero to
sodium valproate.
• Although less certain, there may also be risks associated
with phenobarbital and phenytoin exposure.
53. NEAD STUDY
• Neurodevelopmental Effects of Antiepileptic Drugs
(NEAD) study [Meador et al. 2013]
• NEAD was a prospective observational study of cognitive
development in children exposed in utero to VPA, LTG,
CBZ monotherapy.
54. • A 6-year follow up of 224 children showed that intelligence
quotient (IQ) at age 6 was lower in exposed to VPA (mean
97) compared with CBZ (mean 105), LTG (mean 108)
monotherapy.
• VPA exposure to doses higher than 1000 mg per day had
a negative impact on verbal ability, nonverbal ability,
executive function and memory in exposed children
55. ROLE OF FOLIC ACID IN TREATING
PREGNANT WOMEN WITH EPILEPSY
• Folic acid supplements reduce the risk of NTD
• Folic acid 5 mg once daily is the widely recommended
dose for WWE on AED.
56. PLACE OF VITAMIN K IN PREGNANCY
• All children born to mothers taking enzyme-inducing AEDs
should be given 1 mg of vitamin K parenterally at delivery.
[NICE]
• To avoid bleeding in the newborn.
57. Breast feeding
• Encourage
• Breastfed children may have a higher IQ.
• To minimize infant AED exposure,maternal AEDs should
be kept to a low effective dose, and if signs of potential
adverse reactions noted (lethargy, poor feeding), infant
serum concentrations can be monitored
59. CONTRACEPTION IN WOMEN WITH
EPILEPSY
• Induction of hepatic cytochrome P450 enzyme activity –
Phenytoin ,Pheno.,CBZ etc
• Increases the rate of metabolism of both oestrogen and
progestogen.
• Failure rate of contraceptive pill with AEDs is about twice
that in the general population
60.
61. WWE & CONTRACEPTION
• Depot medroxyprogesterone-acetate (MPA) injections
appear to be effective
• A/E- delayed return to fertility, impaired bone health
• Levonorgestrel intrauterine system (IUS) appears to be
effective, even in women taking EI-AEDs.
62. • In combined oral contraceptives, during the period ‘‘on the
pill’’ lamotrigine levels decrease by approximately 50%,
followed by an increase of lamotrigine levels in the
contraceptive-free week up to 80—100% of the baseline
lamotrigine level
• Result in an increased risk of seizure recurrence
especially in week 2 and 3 on the pill or in concentration-
dependent adverse effects at the end of the pill-free
interval
• Sabers A, Ohman I, Christensen J, Tomson T. Oral contraceptives reduce
lamotrigine plasma levels. Neurology August 26, 2003;61(4):570—1.
63. BONE HEALTH
• AEDS MAY DECREASE BONE MINERAL DENSITY AND
RESULT IN OSTEOPENIA, OSTEOPOROSIS, AND
FRACTURES
• Phenytoin
• Phenobarbiyone
• Valproic acid
• Carbemezepine
• Oxcarbemezepine
64. MENTAL HEALTH
• Psychiatric comorbidity is high in patients with epilepsy
often as a result of AED treatment.
• Prevalence rate of psychiatric conditions in epilepsy
ranges between 20–30%.
• Depression-M/C
• Psychosis
• Peripartum depression,
• Anxiety
65. LEGAL ISSUES
• Social stigma
• Fertility
• Economical issues
• Mental health
• Marriage
• Abortions
• Divorces
66. • Special Marriage Act of 1954 stated that a marriage under
these acts can be solemnized “if at the time of marriage,
neither party suffers from recurrent attacks of insanity or
epilepsy.”
• It took 12 years for Dr. K. S. Mani, often referred as “father
of Indian epilepsy,” and the IEA to have the word
“epilepsy” deleted from this law.
68. Refrences
• Malformation risk of antiepileptic drug exposure during
pregnancy in women with epilepsy: Results from a
pregnancy registry in South India; sv thomas et al;
Epilepsia, **(*):1–8, 2017 doi: 10.1111/epi.13632.
• Management and treatment of women with epilepsy
during pregnancy; Anne Sabers, 3rd Congress of the
European Academy of Neurology Amsterdam, The
Netherlands, June 24 – 27, 2017.
• Practice Parameter update: Management issues for
women with epilepsy—Focus on pregnancy (an evidence-
based review):Obstetrical complications and change in
seizure frequency,harden et al.
69. • Management of epilepsy during pregnancy:an
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