Professional Documents
Culture Documents
BY
Anindhita
Jatu
Valentine
Learning Objectives
3-Be aware of the different AEDs, their toxic effects and the
safest drug that can be used in pregnancy.
Definition and Incidence
B- Generalized Seizures
They occur in more diffuse areas of the brain and they have more serious
effect on the patient. They are further subcategorized as follows:
b-The clonic phase: Seizure is said to enter this phase when the muscles
begin to alternate between relaxation and rigidity. After this phase, the
patient may lose bowel or urinary control.
The seizure usually lasts a total of two to three minutes, after which the
patient remains unconscious for a while and then awakens to confusion and
extreme fatigue.
Classification Of Epilepsy
C- Other Seizures:
1- Atonic (Akinetic) Seizures. A person who has an atonic (or akinetic)
seizure loses muscle tone. Sometimes it may affect only one part of
the body so that, for instance, the jaw slackens and the head drops.
At other times, the whole body may lose muscle tone, and the
person can suddenly fall.
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AED Breast milk/maternal conc Adult half-life NN half-life
______________________________________________________________________
Carbamazepine 0.4–0.6 8–25 8–28
Phenytoin 0.18–0.4 12–50 15–105
Phenobarbital 0.36–0.6 75–126 45–500
Ethosuximide 0.8–0.9 32–60 32–40
Primidone 0.7–0.9 4–12 7–60
Valproic acid 0.01–0.10 6–18 30–60
Lamotrigine 0.6 —— ___
Topiramate 0.69–0.86 —— ___
Zonisamide 0.41–0.93 63 61–109
Levetiracetam 3.09 —— ___
Management
I-Preconceptional Care:
A-Re-assessment: may show that the patient does not have epilepsy
or may reveal a treatable cause before pregnancy (e.g. blood vessel
abnormality in the brain).
I-Preconceptional Care:
E- No trial to stop AED unless the patient is seizure free at least for 2
years. The AED dose should be tapered till stopped completely at
least 6 months prior to any planned pregnancy to provide some
reassurance that seizures are not going to recur.
II-Antenatal Care
A-Investigations:
• Metabolic: serum glucose, urea, electrolytes, Ca & Mg
• EEK
• MRI/CT scan of the head.
B-Drugs:
Monotherapy at the lowest effective dose should be employed. If large daily
doses are needed, use frequent smaller doses or extended-release formula
to avoid high peak levels. Monitoring of serum AEDs level is mandatory.
Usually, women don't suspect they are pregnant until their fourth to sixth
week of pregnancy. By that time, if there are any harmful effects from their
AEDs, most of these effects would have already occurred.
II-Antenatal Care
G-Vitamin K:
Oral 20mg daily is prescribed from 36 weeks until
delivery to mothers taking hepatic enzyme-inducing
drugs (phenytoin, phenobarbitone, primidone,
carbamazepine and topiramate - Not necessary with
sodium valproate).
E- Sleep:
If the mother is breastfeeding, sleep deprivation may be
unavoidable. The mother should make up any missed sleep during
the infant's daytime naps, whenever possible.
IV-Postnatal Care (Cont.)
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Lower hormone level No significant effect
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Phenobarbital Ethosuximide
Phenytoin Valproate
Carbamazepine Gabapentin
Primidone Lamotrigine
Topiramate Tiagabine
Oxcarbazepine Levetiracetam
Zonisamide
Anti-Epileptic Drugs
I-Monitoring
The ideal AED serum free level must be established for each patient
before conception, and should be the level at which seizure control
is the best possible for that patient without debilitating side effects.
Levels should be repeated at the beginning of each trimester and
again in the last 4 weeks of pregnancy. Monitoring should continue
until the 6th to 8th week postpartum. In doing so, one may be able to
avoid symptoms of toxicity that result from the changes in
pharmacokinetics postpartum.
Anti-Epileptic Drugs
I-Monitoring
II-Teratogenicity
Mechanisms:
1-Direct drug toxicity: due to accumulation of the drug metabolites (reactive
intermediates) which are embryotoxic.
Behavioral Teratogenesis
IV-Failure of AEDs
IV-Failure of AEDs
IV-Failure of AEDs
-
1 Epileptic woman can get pregnant. They are not
different than other women population.
4-A woman should not stop AED unless she has not
had seizures for 2 years; gradual discontinuation
can then be attempted.