Epilepsy

Dr.dr.Deviana S. Riu, Sp.OG(K)

Introduction
 Introduction
A seizure is defined as a paroxysmal
disorder of the central nervous system
characterized by an abnormal neuronal
discharge with or without loss of
consciousness.

• Epilepsy is a chronic neurological

condition characterized by recurrent
unprovoked seizures.
• Epilepsy is defined as at least two
unprovoked (or reflex) seizure
 The History should include :

The presence or Seizure description Postictal phase,

absence of an aura by an eyewitness, description, and
including duration. phase

Exacerbating factors Birth history, History of febrile convulsions,

especially when the CNS infections, head trauma
seizure onset is in with loss of consciousness or
the neonatal period known structural lesion in the
Family History or early childhood brain
 EPIDEMIOLOGY
Epilepsy occurs in 0,5% to
0,8% of the general
population, with 5% of
people reporting a seizure at
some time in their life

Vajda and colleagues (2008) reported

Approximately 0,3% to 0,5%
that the risk of seizures during
of all pregnancies are among
pregnancy was decreased by 50 to
women with epilepsy
70 percent if the year before was
seizure free.
 Type of Seizures
FOCAL SEIZURES
 one localized brain area
 Affect a correspondingly localized area of
neurological function
 Result from trauma, abscess, tumor, or
perinatal factors, although a specific lesion
 Cognitive function is not impaired, and
recovery is rapid
 Focal seizures with dyscognitive features are
often preceded by an aura
GENERALIZED SEIZURES
 Involve both brain hemispheres simultaneously
 may be preceded by an aura before an abrupt
loss of consciousness
 followed by tonic contraction of the muscles
and rigid posturing then by clonic contractions
of all extremities while the muscles gradually
relax
 Absence seizures, also called petit mal seizures,
are a form of generalized epilepsy
Epilepsy during Pregnancy
Risk Factor Malformations of cortical
development, head trauma, CNS
infections, family history,
complicated febrile convulsions,
and possibly histroy of difficult
birth or complicated pregnancy
 Effects of Epilepsy on Pregnancy

Preeclampsia

Caesarean Section

Preterm Labor

Late pregnancy bleeding

MATERNAL
 Effects of Epilepsy on Pregnancy

Childhood Epilepsy
Congenital
Stillbirth
malformation
IUGR
FETA anomalies
Valproate 5,9%
Preterm birth L Carbamazepine 2,3%

Lamotrigine 2,1%
Low Birth
weight
Developmental delay
Diagnosis
Women who have remained seizure-free for at least
10 years (with the last 5 years off AEDs) and those
with a childhood epilepsy syndrome who have
reached adulthood seizure- and treatment-free are
considered no longer to have epilepsy
RCOG June 2016
RCOG June 2016
Counseling
 Pre-Conception
• Optimal anticonvulsant management,
preferably monotherapy with the least
teratogenic drug, or at least a reduction in
the number of drugs taken.
during early pregnancy
• Aministered folic acid daily (2-4 mg)
• Physical activity should exclude driving
• Contraception should be discussed.
• Nerugolical consultation
• CREDITS:
Informed thatThis presentation
infants exposed template
with AED
have 4% - 8% risk of congenital icons
was created by Slidesgo, including
by Flaticon, and infographics & images
malformation
by Freepik
• Emphasized that 90% women with epilepsy
have successful pregnancies and deliver
healthy babies
 Pre-natal
• Supplemental folic acid
• A first trimester ultrasound
• Prenatal testing
• Ultrasound at 18-20 weeks
• Fetal echocardiogram
• Neonates should receive vitamin K, 1 mg at birth
 Managements
● Carbamazepine 0.8 – 1.2 mg daily in divided doses
● Phenytoin 150-300 mg daily in two divided doses
● Lamotrigine 300-500 mg/day
● Topiramate 100-400 mg/day
● Levetiracetam 1-3 mg/day

All the AEDs are FDA category C except for the following AEDs that category D :
carbamazepine, phenobarbital, primidone, phenytoin, valproate, and topiramate
Intra partum and Post-
partum Care
• AED medication should be continued in labor
and in the immediate postpartum period
• WWE should be advised to breast feed their
newborns
• Infants should be nursed and carried with some
precautions
• Monitor AED levels through the eighth post
partum week and adjust doses accordingly to
avoid toxicity
30%
Neptune
Neptune is the farthest

70%
Jupiter
Jupiter is the biggest

20%
Mercury
Mercury is the smallest