Week 4

Question 1

What are the four kinds of epileptic seizures?

Answer 1

1. Tonic clonic
2. Abscence seizures
3. Juvenile myoclonic epilepsy
4. Focal seizures

Question 2

What are the common congenital malformations associated with AEDs?

Answer 2

congential heart defects, NTDs, skeletal abnormalities, urinary tract abnormalities, cleft palate

Question 3

What is the pathophysiology of myasthenia gravis?

Answer 3

Acquired auto antibodies against the acetylcholine receptor at neuromuscular junctions, causing impaired nueuromusclar transmisison

Question 3

What are the traits of post natal blues?

Answer 3

Common, 50-80%
Last 48 hours usually
Peak day 5
Commonly day 3-10

Question 4

What is the incidence of post natal depression, what is the recurrence risk and when are the highest risk times for development?

Answer 4

10-15%
1 in 2 to 1 in 3
2-4 weeks and 10-14 weeks

Question 4

What are the risk factors for developing postnatal psychosis, the typical time of onset and risk of recurrence?

Answer 4

1. Risk factors are a sister or mother with PN psychosis (50%), a history of a psychotic disorder (25-50% risk)
2. 50% present by 7days PN, most in the first 2-4 weeks
3. Recurrence 50%

Question 5

Lithium
1. How often should levels be checked in pregnancy
2. What is a toxic level
3. What are signs of toxicity
4. Can you breast feed with it

Answer 5

1. Four weekly until 36 weeks then weekly
2. > 1.2mmol/L
3. nausea, vomiting, cramping, diarrhoea, dystonia, tremors, hyper reflexia, ataxia
4. No - change to sodium valproate or carbemazepine
   With hold in labour

Question 5

Bells palsy
1. What is the increased risk in pregnancy
2. What is the chance of recovery
3. What condition in pregnancy is it linked with?

Answer 5

1. 2-4x
2. If partial palsy 95% if full 85%, reduced chance of recovery when occurs in pregnancy
3. PIH/PET, x 4 risk

Question 6

What is the other name of meralgia paraesthetica and what causes it?

Answer 6

Lateral femoral cutaneous neuropathy
compression of L2-3 while passing under inguinal ligament

Question 7

What is the delta sign on imaging?

Answer 7

Indicates cerebral venous thrombosis, contrast surrounds clot in the superior sagittal sinus.

Question 8

What are the risks associated for Mum and fetus with epilepsy

Answer 8

Mum - PPH, APH, PET/PIH, miscarriage, PTB
Fetus - IUGR, congenital anomalie (urinary tract, cardiac, skeletal, NTD), haemorrhagic disease of the new born, neurodevelopment defects (valproate)

Question 9

Which AEDs are not enzyme-inducing?

Answer 9

lamotrigine, levetiracetam, sodium valproate

Question 10

DDx of seizures in pregnancy?

Answer 10

PET
epilepsy
neuro - cerebral venous sinus thrombosis, PRES (posterior reversible leucoencephalopathy), SOL, reversible cerebral vasoconstirction syndrome.
cardiac - syncope from arrhythmia, AS, vasovagal, carotid sinus sensitivity,
Metabolic - hyponatremia, hypoglycemia, addisonian crisis.
Pseudoseizures (consider if drug resistant)

Question 11

What are the % risks of fetal malformation with:
1. levetiracetam
2. Lamotrigine
3. Carbamazepine
4. sodium valproate
5. phenytoin
6. baseline populaiton

Answer 11

1. 0.7% (limited evidence)
2. 2.9%
3. 4.6%
4. 10.7%
5. 7.3%
6. 3.2%

Question 12

preconceptual counselling for epilepsy?

Answer 12

1. optimise disease - ideally seizure free for one year.
2. start 5mg folic acid. 3/12
3. Counsel on risks to fetus - malformation, IUGR, neurodevelopmental outcomes, haemorrhagic disease of new born
4. Counsel risks to mum - PPH, APH, miscarriage, PTB, sudden death
5. Two-thirds won’t have deterioration of disease
6. counsel about continuing AEDs - risk to her and fetus if seizures.
7. optimise medications - monotherapy, stop sodium valproate, lowest dose possible. Start high dose folic acid
8. offer contraception if not ready
9. consider referral to genetics

Question 13

What is the commonly used cut off for depression with the EPDS?

Answer 13

12 or above

Question 14

How do you diagnose pemphigoid gestationis?

Answer 14

starts periumbilical and involves the umbilicus.
skin biopsy and immunofluorescence - complement deposition in basement membrane
Can sometime detect antibodies in the serum with indirect immunoflouresence

Question 15

What is the impact of pregnancy on myastehnia gravis?

Answer 15

• 1/3 better, 1/3 worse, 1/3 no change
• The course in one pregnancy does not predict the course in another
• Risk of deterioration highest in women who become pregnant within 12 months of diagnosis
• Disease can be flared by: emotional distress & anxiety, intercurrent infection, increased temperature, sub-therapeutic levels of medication causes by pregnancy changes eg vomiting, delayed gastric emptying
  30% will have postpartum exacerbations