Neurological disorders Epilepsy - a common neurological disorder characterized by two or more seizures, - It mainly presents in childhood, although there is a second peak of incidence in older years and women of childbearing age -Seizures result from a sudden excess of electricity to the brain -seizures can be subcategorized as partial and generalized
Complications associated with epilepsy are: Trauma include tongue biting and head or limb injury. Status epilepticus: a seizure lasting for >30 minutes, or a series of seizures without regaining consciousness in between. Sudden Unexpected Death in Epilepsy (SUDEP) of which there is no cause found for the sudden death. Maternal death: the risk of sudden maternal death in pregnancy remains higher in women with epilepsy than those with other long-term conditions.
Treatment is with antiepileptic drugs (AEDs) with monotherapy (one drug) or polytherapy (two or more) -In certain cases surgery or vagus nerve stimulation might be used -Pre-conception care is importance as many AEDs are associated with folate deficiency and fetal abnormalities. - The drug therapy may be changed to monotherapy after careful counselling about the risks of teratogenicity to the fetus and folic acid should be prescribed at an increased dose of 5 mg/day for 12 weeks prior to conception
- It is important to involve family and partners, as they may need to initiate first aid and safety measures -Folic acid of 5 mg/day should be given throughout the first trimester, and if the woman is taking sodium valproate (depakein ) this should continue for all three trimesters. - Women taking AEDs will require oral vitamin K for 4 weeks prior to the baby's birth to decrease the risk of fetal coagulopathy
-AEDs levels should be monitored at regular intervals and the drugs and dosage reviewed by the obstetric team. - The midwife should encourage the woman to comply with the prescribed medication. - avoid bathing alone, and to keep bathroom doors unlocked in case of a seizure. -Screening for fetal anomalies - ultrasound scan is offered between 18 and 22 weeks of pregnancy. - discuss a realistic birth plan, and be aware that water birth is contraindicated on safety grounds
-The management principles for an epileptic seizure are the same as for eclampsia -Anticonvulsant medication is continued throughout labor -If seizures recur, short-acting benzodiazepines are administered -The woman should not be left alone in labor, Labor Dehydration Hyperventilation exhaustion should be avoided as they can all trigger a seizure. -differential diagnosis of eclampsia
-Pethidine is contraindicated as it is metabolized to norpethidine which can also induce seizure - trans-electrical nerve stimulation (TENS) or epidural should be considered as an alternative. The birth can be spontaneously facilitated by the midwife. Following obtaining informed consent from the woman, vitamin K should be administered to the baby promptly aher birth to protect against AED-induced hemorrhagic disease
24 hours following the birth the woman has an increased risk of a seizure and so should remain in hospital. Breastfeeding is encouraged and the medical team and pharmacist should discuss suitable AEDs while lactating. The baby should be carefully observed and any concerns reported to the paediatrician immediately. Antiepileptic drugs affect hormonal contraceptives and alternative contraception such as barrier methods are recommended
Advice should be given about safety when caring for the baby in case of maternal seizure. The midwife should encourage the woman to dress, change and feed the baby on a changing mat on the floor to prevent falling during a seizure while attending to the baby. It is advisable that the baby is bathed by the mother in shallow water when someone else is around to assist if necessary and a carrycot or baby car seat should be used to carry the baby up and down stairs
When parents choose a pram/buggy for their baby, the midwife should advise them to ensure that they select one with brakes that initiate when the handle is released