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Epilepsy in Pregnancy

From Mediwikis

Approximately 0.5% of pregnant women have epilepsy. Pregnancy can lead to a worsening of epilepsy, with women having more seizures than usual, especially in labour where lack of sleep and hyperventilation can induce seizures. Epileptic fits in pregnancy aren’t the end of the world, as the fetus is resistant to short durations of hypoxia and therefore are not affected by a single seizure too much. However, recurrent fits or status epilepticus can lead to hypoxic damage or spontaneous abortion. Generally, stable, well-controlled epilepsy is not a big problem and will not require too much additional management.
Almost all anti epileptics are teratogenic (Lamotrigine is the least), however they should be continued where needed as uncontrolled epilepsy and recurrent fits are worse for the baby and put the mother at a real risk of death. Monotherapy is also favoured as it is less teratogenic than polypharmacy.

Management

Pre-Conception

  • Start taking 5 mg (high dose) folic acid as soon as they start trying to get pregnant – ideally taking it 12 weeks before conception, and continuing to take it for the duration of the pregnancy.
  • Consult their neurologist to let them know their plans to get pregnant, so any medications can be adjusted (anti epileptics are teratogenic)
  • Pre-conception counselling should include information of the risks for both the mother and foetus, mothers may want to know the risk of their children having epilepsy (~3%)

During the pregnancy

  • 16 week scan, looking for neural tube defects, facial deformities or cardiac deformities
  • Subsequent growth scans are performed dependant on polypharmacy and anti epileptics
  • 20 mg of vitamin K in last 4 weeks of pregnancy as baby is at a high risk of cerebral haemorrhage.
  • 20 mg IM of vitamin K at birth, again to reduce risk of haemorrhagic disorders of the new-born (caused by maternal anti epileptics preventing transfer of vitamin K across the placenta)
  • Epilepsy is not an indication for induction of labour
  • Keep in mind that mothers with epilepsy could also develop pre-eclampsia and remember to rule out eclamptic fits