Epilepsy And Pregnancy: All You Need To Know

Epilepsy is also known as a seizure disorder. A seizure is a brief temporary disturbance in the electrical activity of the brain.

Dr. Murali Chekuri, Consultant neurology, Manipal Hospitals, Vijayawada

Epilepsy is also known as a seizure disorder. A seizure is a brief temporary disturbance in the electrical activity of the brain. It is a neurological disorder in which brain activity becomes abnormal. In 40% cases, it occurs due to brain trauma, infection in the brain, injury, or tumour, and in the case of the other 60% patients, no identifiable cause is seen.

Epilepsy causes seizures or periods of unusual behaviour, unusual sensations, and sometimes loss of awareness. It affects both males and females irrespective of age, race, or ethnic background. It may occur as a result of a genetic disorder or an acquired brain injury, such as trauma or stroke. Even today 4 out of 10 people in the industrialized world do not receive appropriate treatment. This ratio is high in the case of developing nations, where 8 out of 10 people do not get adequate treatment for this medical condition.

In India, 0.5-1.0% of its population is affected by epilepsy.

Symptoms of epilepsy vary depending on the type of seizure. Some Conditions Mimic Like Seizures For Example Syncope, Hypoglycaemic attacks, Transient ischemic attacks, Panic attacks, Physiological jerks during sleep, breath-holding spells in children, and Psychogenic episodes.

There are two types of epilepsy — partial and generalized. These are based on how and where the abnormal brain activity begins. Seizures that appear to involve all areas of the brain fall in the generalized category. Within the generalized seizures there are 6 types:

  • Absence Seizures (Staring and blinking)
  • Myoclonis Seizures (Brief jerking movements, usually of upper body)
  • Tonic-Clonic (Going stiff and falling – followed by convulsions (jerking movements)
  • Tonic (Going stiff and falling but without convulsions)
  • Atonic (Falling limply to the ground)

Diagnosis & Treatment 

EEG is the most common test to diagnose epilepsy. The electrodes record the electrical activity of the brain and diagnose it. Patients with epilepsy may still get seizures due to failure to take medication at the right time. Sleep deprivation, Stress, Dehydration, Alcohol or drug use or withdrawal, Hormonal Fluctuations, Flashing lights, are common triggers for seizures reoccurrence. Accurate diagnosis of patient’s seizure type and where seizures begin provide the best chance for finding effective treatment. Epilepsy patients have to maintain a seizure diary, do regular follow-ups with the doctor, and AED compliance.

The average risk of secondary seizure following a single unprovoked seizure is 35-40%. Generally, the first seizure cannot be treated. Prolonged focal seizure, first seizure as status epilepticus, presence of focal deficit, family history of seizures, EEG abnormality, and abnormal neuroimaging in these circumstances a single seizure may be treated. In India, two types of treatment options are available, primary treatment and secondary treatment. In primary treatment, the doctor uses anti-epileptic drug therapy or surgery to treat epilepsy. In case of secondary options, doctors apply Vagal Nerve Stimulator, Ketogenic diet, Psychological or complementary therapy to help the patient recover from epilepsy.

Epilepsy and Pregnancy

90% of women with epilepsy syndrome have normal pregnancy and delivery. All patients should be taking folic acid 5mg/day. During pregnancy in 25%, seizures may remain unchanged. In 50% of women, it could improve and in around 25% of women, it can get worse. All patients should be given two doses of VIT-K 10mg IM at 34-36 weeks of pregnancy and also fetal malformations screening (16 weeks – 18 weeks) is a must. All infants born to mothers taking AEDs should be given Vitamin K 1-mg IM at birth. The overall incidence of fetal abnormalities in children born to mothers with epilepsy is 5–6%, compared to 2–3% in healthy women. The patient has to take the anti-seizure medication exactly as prescribed by doctor during pregnancy. Uncontrolled seizures could pose a greater risk to your baby than any medication. It is also important to make healthy lifestyle choices like taking prenatal vitamins, getting enough sleep, avoid smoking, alcohol, illegal drugs, and caffeine.

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