What are the features of pregnancy in patients with epilepsy?
In 1-2% of cases there is a chance of developing status epilepticus. In 5% of cases, there is an increase in attacks during childbirth or the labor period. However, most pregnant women have a favorable outcome in 90% of cases. Hypotheses explaining the occurrence of attacks are hormonal changes during pregnancy, metabolic increase in sodium and fluid retention, psychological increase in stress and anxiety, physiological sleep deprivation. And changes in the pharmacokinetic properties of antiepileptic drugs.
Features of pregnancy management in women with diagnosed epilepsy
The main specialist with whom the woman will be observed throughout the entire gestational period is an obstetrician-gynecologist. In the normal course of pregnancy, examinations are carried out at the following times:
- 1 time per month until 28 weeks;
- 2 times a month – from 28 to 36 weeks;
- every week from 36 until delivery.
Pregnant patients with epilepsy, in addition to scheduled visits to the obstetrician-gynecologist, should be observed by an epileptologist:
- with complete control of seizures - once every two months;
- for periodically developing attacks - from once a month and more often if the attending physician considers it necessary.
Specialists who do not have sufficient knowledge in the field of epilepsy treatment - gynecologists, pediatricians, neonatologists - fearing the negative effect of antiepileptic drugs on the body of the developing fetus may try to persuade a woman to refuse treatment. It is the competence of an epileptologist to cancel drug therapy or revise regimens and medications, so making any adjustments is possible only after preliminary consultation with the attending physician.
The treatment regimen and antiepileptic drugs used during gestation are developed and selected individually, taking into account the course of pregnancy and the disease. It is important to remember that dosages should be as minimal as possible, but a specialist should select the amount of the drug.
Monotherapy is recommended - taking only one drug. This approach makes it possible to control the disease and at the same time reduce the teratogenic effect of drugs on the developing fetus. It is also strongly recommended not to change the drug from one manufacturer to another.
In what cases is pregnancy contraindicated for a woman with epilepsy?
Pregnancy is not contraindicated during stable drug remission.
What is drug remission?
According to medical literature, this is the absence of epileptic seizures in a woman for one year. The longer a woman's remission before pregnancy, the better the prognosis. In case of pharmacoresistant course of the disease, in case of status epilepsy, in the presence of mental disorders in women, planned pregnancy is contraindicated.
Another thing is that women from this group sometimes come to the doctor already pregnant. In this case, if a woman was taking polytherapy with anticonvulsants, it is necessary to try to switch her to monotherapy. However, the possibility of translation inefficiency should be taken into account. Monotherapy for the treatment of epilepsy should be carried out with modern drugs with low teratogenic activity. In this case, it is necessary to use therapeutic drug monitoring and examine the concentration of drugs in the blood. The concentration of anticonvulsants must be checked once a month; if the dose is increased, there should be an increase in concentration.
It must be remembered that there is not a single safe antiepileptic drug. Because there is a potential for seizures and adverse effects on fetal development. This is a difficult task. The most important thing is to prevent a seizure; if focal seizures occur, this can be controlled. Frequent complications: intrauterine growth retardation, risk of obstetric complications, perinatal asphyxia. Antenatal and perinatal infant mortality is more common. At the same time, maternal mortality is 10 times higher than in the population. The cause of maternal mortality was uncontrolled seizures, which arose due to the fact that the woman independently stopped taking the drug.
Let's consider the side effects of taking antiepileptic drugs; they include fetal hypoxia, trauma, intrauterine growth retardation, various desmorphisms, and large malformations. The probability of this in the population is no more than 1-2%, in women suffering from epilepsy and taking anticonvulsants from four to 9%. As noted by authors studying patients with epilepsy, the most common complication is teratogenic complications. This risk is greatest during uncontrolled seizures during pregnancy. Therefore, the general strategy is to maintain seizure control with medications that have minimal side effects on mother and baby. Congenital deformity is defined as a physical defect of the skull, spinabifida, cleft palate, or isolated damage to the fetal facial bones. Neuronal tube defects are ten times more common, defects of the genitourinary system are three times more common.
Thus, when planning pregnancy in patients with epilepsy, consultation with a neurologist-epileptologist is necessary for the correction of anticonvulsants and pregnancy management together with an obstetrician-gynecologist.
At the First Neurology clinic you can contact one of three epilepsy specialists.
Epilepsy during pregnancy - more than 15 seizures
Marina
284 views
November 1, 2020
Hello. I'm 11 weeks pregnant and I probably have epilepsy. There were no previous seizures. Starting from the 4th week of pregnancy, nausea, abdominal pain, reaction to smells, weakness, and drowsiness began. According to the ultrasound, everything is normal. A week later, the condition worsened: almost constant abdominal pain, severe headaches in the forehead area; In the evening, vomiting began with loss of consciousness and chaotic movements of the arms and legs. There were more than 10 attacks according to the same pattern: lightheadedness -> loss of consciousness with throwing back of the head and rolling back of the pupils -> a feeling of fear, vomiting. After an attack, the pressure rises sharply. I was in the hospital for 10 days, but they could not make a diagnosis. I described the situation here https://sprosivracha.com/questions/316352-beremennost-na-fone-prolaktinomy-toshnota-boli-obmoroki In the hospital they put infusions with magnesium for 5 days. Against this background, the attacks did not recur. A few days after finishing the course of magnesia, the condition worsened: nausea again, then there were three more attacks within 5 days. Finally, I was able to consult a neurologist. She assumed that I had epilepsy and prescribed Lamictal 12.5 g 2 times a day for the first week, then 25 g 2 times a day for another 3 weeks. She told me to do an EEG in a month. With Lamictal I felt better: I didn’t have attacks for 2 weeks, I was able to eat better. However, abdominal pain, hiccups, belching, and nausea remain. Then insomnia, weakness, and increased nausea appeared (the last few days). Yesterday morning I had very strong nausea. To somehow relieve it, I took one tablet of Cerucal. The nausea went away a little, but the stomach to the right of the navel hurt very badly, and there was also a strong rumbling in the stomach. I took no-shpa, after which I vomited. Then I had FIVE epileptic seizures - every 2 hours. Only at midnight they stopped, but I still slept poorly. Today the pressure is 85/60. Weight now is 47.5 kg with a height of 165. I feel very nauseous and have difficulty eating literally a spoonful of porridge. I drink practically nothing - water makes me sick. The appointment with the doctor who consulted me was booked for a long time. I'm also not entirely sure that I have epilepsy. Please help me figure out: 1. What to do if attacks recur? In what situation is hospitalization necessary? 2. What examinations need to be completed? 3. I have had more than 17 seizures in the last 3 weeks. How can this affect the child? 4. What is the indication for termination of pregnancy? I'm very afraid that it will get worse.
The question is closed
epilepsy
attack
very sick
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Yushina Maria Alexandrovna
Head of the Center for Epilepsy and Paroxysmal Conditions.
The doctor is a neurologist. Epileptologist. Ozone therapist. Physiotherapist Experience: 7 years.
Volkova Svetlana Anatolevna
The doctor is a neurologist of the highest category. Epileptologist. Ozone therapist. Physiotherapist. Experience: 26 years.
Kordonskaya Irina Sergeevna
Pediatric neurologist of the highest category. Epileptologist. Neurophysiologist (EEG diagnostic doctor). Experience: 24 years.
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Head of the Center for Diagnostics and Treatment of Sleep Disorders.
The doctor is a neurologist of the highest category. Vertebrologist. Somnologist. Epileptologist. Botulinum therapist. Physiotherapist. Experience: 23 years.
Tarasova Svetlana Vitalievna
Expert No. 1 in the treatment of headaches and migraines. Head of the Center for the Treatment of Pain and Multiple Sclerosis.
Somnologist.
Epileptologist. Botulinum therapist. The doctor is a neurologist of the highest category. Physiotherapist. Doctor of Medical Sciences.
Experience: 23 years.Palagin Maxim Anatolievich
The doctor is a neurologist. Somnologist. Epileptologist. Botulinum therapist. Physiotherapist. Experience: 6 years.
When is pregnancy contraindicated for epilepsy?
Although the prognosis for pregnancy with a controlled course of the disease is favorable, there are a number of contraindications to conception. A woman diagnosed with epilepsy is prohibited from becoming pregnant in the following cases:
- severe course of the disease with regular generalized attacks;
- the course of epilepsy with the development of epistatus;
- diagnosing pronounced changes in the psyche that pose a threat to both mother and child.
The Extendiagnostics mobile center conducts EEG video monitoring at patients’ homes and at the clinic. The interpretation of the results obtained and the subsequent prescription of treatment are carried out by specialists with extensive practical experience. You will be pleased with the prices for the proposed research. You can make an appointment by calling...
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