Epilepsy and Pregnancy

Epilepsy and Pregnancy Patient Information Epilepsy is a neurological condition, which affects the nervous system, and is also known as a seizure disorder. The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word “Epilepsy” does not indicate anything about the cause of the person’s seizures, what type they are, or how severe they are. A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. About half of the people who have one seizure without a clear cause will have another one, usually within 6 months. You are twice as likely to have another seizure if you have a known brain injury or other type of brain abnormality. If you do have two seizures, there’s about an 80% chance that you’ll have more. If your first seizure occurred at the time of an injury or infection in the brain, you are more likely to develop epilepsy.More seizures are also likely if your doctor finds abnormalities on a neurological examination; a set of tests of the functioning of your nervous system that is performed in the doctor’s office. Another thing that can help your doctor predict whether you will have more seizures is an EEG, electroencephalogram, a test in which wires attached to your scalp record your brain waves. Certain patterns on the EEG are typical of epilepsy. If your brain waves show patterns of that type, you are about twice as likely to develop epilepsy as someone who does not have those patterns. When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning. Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor. The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion. The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “Post–ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti–seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post–ictal period, much like a person waking up from anesthesia after an operation. Epilepsy can develop in any person at any age. 0.5% to 2% of people will develop epilepsy during their lifetime. People with certain conditions may be at greater risk. More men than women have epilepsy. Bookmark Pregnant Women with Epilepsy Pregnancy is a very important event especially so in the life of women with epilepsy. The main concern in the patient and her relatives mind is whether any thing would happen to the baby is it safe to carry on with the pregnancy. The health of the mother (patient) is also a concern, though to a lesser extent. During pregnancy, various things to be considered are • Risks of baby being born physically or mentally deformed . • Risk of epilepsy in the offspring. • Risks to mother or baby during delivery. Risk to the baby does exist, and this would be partly due to the anti epileptic medications and partly due to the seizures themselves, which if frequent, could lead to lack of oxygen to the baby. The risk from medicines is about double (5-6%) when compared to women not on anti epileptic medicines. These take the form of neural tube defects (improper development of brain and /or spinal cord), or facial deformities. Thus though there is a risk of improper development, this is not too great and most pregnancies pass of uneventfully. Certain medicines like evaporate are known to cause a greater proportion of defects and if possible these need to be changed to some other drug. This has to be done prior to the pregnancy as the risk of fetal defects is highest in first 3 months. Most of the other routinely used medicines have more or less equal risk so there is nothing much to choose between them. Some gynecologists have their individual preferences, as do neurologists, so this decision needs to be taken jointly. As opposed to risk to baby due to medicines, there are risks of seizures also, and seizures need to be well controlled prior to planning pregnancy. Each seizure causes temporary reduction in oxygen supply to the baby and this may lead to poor growth, or in occasional cases abortions or fetal deaths. The decision about anti epileptic medicines in pregnancy should be taken before the patient gets pregnant, and pre-pregnancy counseling is an important aspect, which is most often lacking, partly because of the doctors who are not thinking too far ahead and partly due to patients who are too shy to discuss this with their neurologists and prefer to approach the doctor only after pregnancy is confirmed. Prior to considering pregnancy, the patient’s fits must be controlled and ideally patient should be 6-12 months fit free. This is sometimes a problem because of our society and hence extra counseling is necessary. If the patient is well controlled and on multiple medicines then the doctors try and keep only one of these and reduce the others If patients are on valproate, then this should be changed to one of the other medicines, always ensuring that the seizure control is not affected. This process may take 3-6 moths. Certain types of fits do not respond to other medicines and there may be no option but to continue valproate. In such cases the doctor tries to keep the dose as low as possible, and the risk of Mal development must be discussed in detail with the patient and husband. Other measures to be taken during pregnancy are ensuring proper food timings, and sleep; reducing stress. Occasionally the level of the medicines would have to be checked and if too low then dose would be increased accordingly. Folic acid supplements are now routinely used and the help prevent neural tube defects in baby. Period ultrasound examinations also help to detect fetal problems. {jumi usermod/ads/ads.php}{/jumi} During last month of pregnancy there is substantial weight gain and this may lead to the medicine getting diluted. Drug level monitoring often helps to readjust doses, which would continue till delivery. During delivery (normal or caesarian) the same doses have to be continued. Breast feeding is by and large safe and babies are not affected by most drugs unless the dose is quite high. This needs to be discussed with the doctors. Risk to the mother is negligible, unless patient develops uncontrolled seizures. Or she develops eclampsia (high BP, Swelling of feet, Kidney Involvement). Lastly, about 5-10% of epilepsies are inherited so that is the risk of baby developing seizures later in life. Epilepsies have many different types and only a few of these are genetic in origin. In any case, treatment of the sits is no different from the non genetic varieties. Even so, it would not mean that the child would be mentally handicapped, and hence this aspect should not be a barrier to considering pregnancy. All said, pregnancy in an epileptic mother needs careful monitoring and assessment. Though there are increased risks, these are not prohibitive and can be minimized to some extent and most pregnancies pass off uneventfully.