Download Epilepsy

Epilepsy:
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-Epilepsy is chronic neurological disorder.
- It can affect anyone at any age but the
disorder commonly develops before 20
years of age.
-30% of cases occurring in early
childhood.
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-Epilepsy is chronic neurological disorder.
- It can affect anyone at any age but the
disorder commonly develops before 20
years of age.
-30% of cases occurring in early
childhood.
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-Because the incidence of maternal death
with epilepsy is increasing ,so
-women with epilepsy are receiving
appropriate information and counseling
about contraception, conception and
pregnancy so that they can make
informed decisions about their care .
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• care is provided by a multidisciplinary team
comprising a named midwife, obstetrician and
neurologist in order to prevent significant
morbidity/mortality in either the mother or fetus
Etiology:
-An epileptic seizure results from abnormal
electrical activity in the brain
-disturbances of sensory, motor and autonomic
function.
-These disturbances recur spontaneously and
are classified according to the parts of the brain
affected.
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- Seizures may be described as
1-partial, usually arising from the temporal
or frontal lobe of the brain,
2- generalized, resulting from disturbances
involving both halves of the brain.
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* General seizures classified as
1-absence seizures (petit mal)
2-myoclonic seizures
3- tonic-clonic seizures (grand mal)
4- atonic seizures
5- status epilepticus
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The cause of epilepsy in most instances is
unknown.
1- a genetic component,
2- hypoglycemia
3- encephalitis
4- meningitis
5- cerebral hypoxia
6- toxicity from alcohol or drugs
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-structural damage or abnormality of the
brain may result in epilepsy.
Precipitate factor;
1-emotional stress
2- sleep deprivation
3-physical exhaustion
4-increased body temperature (fever, hot
environments)
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5- environmental factors (strobe lighting,
noise)
6-non-compliance with drug therapy.
7-hormonal changes at the onset of
menstruation may trigger epileptic
seizures
Diagnosis:
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-Identification the type
-identification cause of epilepsy
-taking a clear history including eyewitness
- blood tests to determine hematology,
biochemistry and toxicology assays
-magnetic resonance imaging (MRI)
- computerized tomography (CT)
-electroencephalogram (EEG)
-neuropsychological assessment to evaluate any
learning disability and cognitive dysfunction
Treatment
-the use of one antiepileptic drug (AED).
-In some individuals a combination of
drugs (polytherapy) may be required
-a few will require surgery.
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-side-effects of(AED).
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-drowsiness
-sedation
- nausea and skin rashes.
- better to use a single AED prescribed at
the lowest effective dose.
- AED therapy must be started under the
guidance of a specialist physician and will
need to be reviewed at regular intervals
and at a minimum once a year
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Women who take AEDs have a 4% chance
of having a baby with a major congenital
malformation ,drug will need to be
reviewed and adjusted in pregnancy in
order to reduce this risk
Health education
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knowledge of epilepsy in general
• the significance of trigger factors which
may precipitate a seizure
• a guide to AEDs, how they work, their
side effects and the importance of
compliance
• an explanation of what happens during
a seizure, recognizing status epilepticus,
what to do and when to get medical help
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implications for employment, education,
sports activities, driving and maintaining
independent living
• psychological and sociological issues
• effects of treatment on fertility and
pregnancy and the risk of congenital
abnormalities
• sudden death in epilepsy
Effect of epilepsy on the fetus
and neonate
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Some women may experience an increase
in seizures and the risk of complications in
pregnancy is increased when epilepsy is
poorly controlled
Epilepsy increase during
pregnancy due to :
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non-compliance with the drug regimen
sleep deprivation during pregnancy
the decline in plasma concentrations of
the AED as the pregnancy progresses.
-Prolonged and/or serial seizures during
pregnancy increase the risk of fetal
morbidity and mortality caused by
hypoxia or placental abruption
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- the first aid measures that should be adopted
following an epileptic seizure, prevent aspiration,
the dangers of hot baths inducing fainting and
consequent drowning and the risk of death
-The majority of women on antiepileptic drugs
have physically normal babies, however
evidence suggests increased risk of major
congenital malformations in babies of women
with epilepsy
Pre-pregnancy care
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-Preconception advice is essential for women
with epilepsy and a review of AED therapy
-the gradual withdrawal of AED therapy may be
considered prior to pregnancy in order to reduce
the risk of congenital malformation in the fetus.
-Folic acid supplementation (5 mg/day) should
be commenced before pregnancy and continued
throughout pregnancy to prevent congenital
malformation and the development of anaemia .
Antenatal care
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-Pregnancy has no effect on seizure control and
most women with epilepsy will remain seizure
free
- Close monitoring of the maternal and fetal
condition is required and antenatal care should
be provided by a multidisciplinary team which
includes a named midwife, obstetrician and a
neurologist or physician with a specialist interest
in epilepsy in pregnancy
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-u\s at 18–22 weeks.
-Epilepsy is not an indication for early
induction of labour or elective caesarean
section.
Intrapartum care
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-labour and birth carry an increased risk for
tonic-clonic seizures
-Careful observation and monitoring of the
maternal and fetal condition by the midwife is
required through labour and the early postnatal
period.
- AEDs should be administered as scheduled
throughout labour and it is important to prevent
the development of possible ‘trigger’ situations
such as:
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1- sleep deprivation
2- hypoglycemia
3- stress
4- hyperventilation
5- anemia
-Women with epilepsy should be offered
the same choices for pain relief in labour
as other women, including epidural
analgesia.
Postnatal care:
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-at an increased risk of seizures due to
fluctuating hormone levels and sleep
disturbance.
-Safety precautions in the home should be
discussed with the woman and her
partner.
- This will include giving advice about how
to minimize risks when feeding, bathing,
changing and transporting the baby
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-AEDs cross the placenta freely and decrease
production of Vitamin K leading to the risk of
Vitamin K deficiency bleeding in the newborn
-This can be prevented by routine administration
of oral vitamin K (20 mg/day) to the mother
from 36 weeks' gestation and to the baby (1 mg
i.m.) shortly after birth .
- Breastfeeding is generally safe. How much AED
passes into breast milk must be considered
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-Some AEDs have a sedative effect, causing
drowsy babies less efficient at feeding and
gaining weight more slowly.
-AED therapy should be reviewed soon after
birth by the neurology team .
- Future pregnancy plans should be discussed
and appropriate contraceptive advice given.
-All methods of contraception are available to
women with epilepsy
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- oral contraceptives are less effective with
some AEDs .
-Women taking these AEDs will require
oral contraceptives with a higher dosage
of estrogen