Epilepsy

Question 1

What is epilepsy?

Answer 1

• common neurological condition with a tendency to have recurrent seizures
• a seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temperature disruption in the normal message passing between cortical neurones
  —> this disruption results in the brains messages becoming halted or mixed up depending on the site and extent of activity within the brain
• seizures can be broadly classified into two categories
  —> partial seizures - commonly affects the temporal lobe, remain conscious, can sometimes occur before a secondary generalised seizure
  —> generalised seizures - whole brain is affected straight away without warning and person is usually unconscious

Question 2

What may be the complications of epilepsy?

Answer 2

• status - epilepticus - a seizure that lasts >30 min or longer or a series of seizures without regaining consciousness in between, can be fatal
• sudden unexpected death in epilepsy - phenomenon whereby a person with epilepsy suddenly dies
• trauma - occurring at the time of convulsion
• maternal mortality

Question 3

What are some of the issues in pregnancy associated with epilepsy?

Answer 3

• some women may see an increase in the frequency of seizures in pregnancy, majority see no change or a decrease
• tonic clinic seizures have relatively low risk to fetus but could influence further cognitive development
• all anti-epileptic drugs cross the placenta
• major congenital malformation occur in <5% of fetuses of women taking AED’S
• increased risk of folate deficiency and NTD

Question 4

What is the midwives role in pregnancy?

Answer 4

• detailed booking history with emphasis on current drug therapy
• refer to consultant led unit
• advocate importance and compliance with AEDs therapy
• encourage BF and discus post-delivery safety issues

Question 5

What are some of the issues in labour?

Answer 5

• risk of tonic clonic seizure during labour is 1-2%
• hyperventilation, exhaustion, dehydration, emotional stress and pain can induce a seizure
• prolonged or repeated seizures can cause fetal hypoxia
• status epilepticus is a medical emergency
• pethidine is metabolised to norpethidine and may induce a seizure
• continue normal AED regime

Question 6

What is the role of the midwife in labour?

Answer 6

• do not leave alone in labour
• use of birthing pool is contraindicated
• ensure compliance and continuance of AEDs
• limit stress and anxiety and ensure adequate hydration
• avoid exhaustion and hyperventilation
• consider appropriate pain relief

Question 7

What are some of the postpartum issues?

Answer 7

• first 24 hours there is a 1-2% risk of tonic clonic seizures
• enzyme inducing AEDs have been shown to interfere with vitamin K metabolism in the newborn
• AEDs are secreted in breast milk but levels lower in utero