Epilepsy:

-Epilepsy is chronic neurological disorder. -Epilepsy is chronic neurological disorder. - It can affect anyone at any age but the disorder commonly develops before 20 years of age. - It can affect anyone at any age but the disorder commonly develops before 20 years of age. -30% of cases occurring in early childhood. -30% of cases occurring in early childhood.

-Epilepsy is chronic neurological disorder. -Epilepsy is chronic neurological disorder. - It can affect anyone at any age but the disorder commonly develops before 20 years of age. - It can affect anyone at any age but the disorder commonly develops before 20 years of age. -30% of cases occurring in early childhood. -30% of cases occurring in early childhood.

-Because the incidence of maternal death with epilepsy is increasing,so -Because the incidence of maternal death with epilepsy is increasing,so -women with epilepsy are receiving appropriate information and counseling about contraception, conception and pregnancy so that they can make informed decisions about their care. -women with epilepsy are receiving appropriate information and counseling about contraception, conception and pregnancy so that they can make informed decisions about their care.

care is provided by a multidisciplinary team comprising a named midwife, obstetrician and neurologist in order to prevent significant morbidity/mortality in either the mother or fetus care is provided by a multidisciplinary team comprising a named midwife, obstetrician and neurologist in order to prevent significant morbidity/mortality in either the mother or fetus Etiology: Etiology: -An epileptic seizure results from abnormal electrical activity in the brain -An epileptic seizure results from abnormal electrical activity in the brain -disturbances of sensory, motor and autonomic function. -disturbances of sensory, motor and autonomic function. -These disturbances recur spontaneously and are classified according to the parts of the brain affected. -These disturbances recur spontaneously and are classified according to the parts of the brain affected.

- Seizures may be described as - Seizures may be described as 1-partial, usually arising from the temporal or frontal lobe of the brain, 1-partial, usually arising from the temporal or frontal lobe of the brain, 2- generalized, resulting from disturbances involving both halves of the brain. 2- generalized, resulting from disturbances involving both halves of the brain.

* General seizures classified as * General seizures classified as 1-absence seizures (petit mal) 1-absence seizures (petit mal) 2-myoclonic seizures 2-myoclonic seizures 3- tonic-clonic seizures (grand mal) 3- tonic-clonic seizures (grand mal) 4- atonic seizures 4- atonic seizures 5- status epilepticus 5- status epilepticus

The cause of epilepsy in most instances is unknown. The cause of epilepsy in most instances is unknown. 1- a genetic component, 1- a genetic component, 2- hypoglycemia 2- hypoglycemia 3- encephalitis 3- encephalitis 4- meningitis 4- meningitis 5- cerebral hypoxia 5- cerebral hypoxia 6- toxicity from alcohol or drugs 6- toxicity from alcohol or drugs

-structural damage or abnormality of the brain may result in epilepsy. -structural damage or abnormality of the brain may result in epilepsy. Precipitate factor; Precipitate factor; 1-emotional stress 1-emotional stress 2- sleep deprivation 2- sleep deprivation 3-physical exhaustion 3-physical exhaustion 4-increased body temperature (fever, hot environments) 4-increased body temperature (fever, hot environments)

5- environmental factors (strobe lighting, noise) 5- environmental factors (strobe lighting, noise) 6-non-compliance with drug therapy. 6-non-compliance with drug therapy. 7-hormonal changes at the onset of menstruation may trigger epileptic seizures 7-hormonal changes at the onset of menstruation may trigger epileptic seizures

Diagnosis: -Identification the type -Identification the type -identification cause of epilepsy -identification cause of epilepsy -taking a clear history including eyewitness -taking a clear history including eyewitness - blood tests to determine hematology, biochemistry and toxicology assays - blood tests to determine hematology, biochemistry and toxicology assays -magnetic resonance imaging (MRI) -magnetic resonance imaging (MRI) - computerized tomography (CT) - computerized tomography (CT) -electroencephalogram (EEG) -electroencephalogram (EEG) -neuropsychological assessment to evaluate any learning disability and cognitive dysfunction -neuropsychological assessment to evaluate any learning disability and cognitive dysfunction

Treatment -the use of one antiepileptic drug (AED). -the use of one antiepileptic drug (AED). -In some individuals a combination of drugs (polytherapy) may be required -In some individuals a combination of drugs (polytherapy) may be required -a few will require surgery. -a few will require surgery.

-side-effects of(AED). -drowsiness -drowsiness -sedation -sedation - nausea and skin rashes. - nausea and skin rashes. - better to use a single AED prescribed at the lowest effective dose. - better to use a single AED prescribed at the lowest effective dose. - AED therapy must be started under the guidance of a specialist physician and will need to be reviewed at regular intervals and at a minimum once a year - AED therapy must be started under the guidance of a specialist physician and will need to be reviewed at regular intervals and at a minimum once a year

Women who take AEDs have a 4% chance of having a baby with a major congenital malformation,drug will need to be reviewed and adjusted in pregnancy in order to reduce this risk Women who take AEDs have a 4% chance of having a baby with a major congenital malformation,drug will need to be reviewed and adjusted in pregnancy in order to reduce this risk

Health education knowledge of epilepsy in general knowledge of epilepsy in general the significance of trigger factors which may precipitate a seizure the significance of trigger factors which may precipitate a seizure a guide to AEDs, how they work, their side effects and the importance of compliance a guide to AEDs, how they work, their side effects and the importance of compliance an explanation of what happens during a seizure, recognizing status epilepticus, what to do and when to get medical help an explanation of what happens during a seizure, recognizing status epilepticus, what to do and when to get medical help

implications for employment, education, sports activities, driving and maintaining independent living implications for employment, education, sports activities, driving and maintaining independent living psychological and sociological issues psychological and sociological issues effects of treatment on fertility and pregnancy and the risk of congenital abnormalities effects of treatment on fertility and pregnancy and the risk of congenital abnormalities sudden death in epilepsy sudden death in epilepsy

Effect of epilepsy on the fetus and neonate Some women may experience an increase in seizures and the risk of complications in pregnancy is increased when epilepsy is poorly controlled Some women may experience an increase in seizures and the risk of complications in pregnancy is increased when epilepsy is poorly controlled

Epilepsy increase during pregnancy due to : non-compliance with the drug regimen non-compliance with the drug regimen sleep deprivation during pregnancy sleep deprivation during pregnancy the decline in plasma concentrations of the AED as the pregnancy progresses. the decline in plasma concentrations of the AED as the pregnancy progresses. -Prolonged and/or serial seizures during pregnancy increase the risk of fetal morbidity and mortality caused by hypoxia or placental abruption -Prolonged and/or serial seizures during pregnancy increase the risk of fetal morbidity and mortality caused by hypoxia or placental abruption

- the first aid measures that should be adopted following an epileptic seizure, prevent aspiration, the dangers of hot baths inducing fainting and consequent drowning and the risk of death - the first aid measures that should be adopted following an epileptic seizure, prevent aspiration, the dangers of hot baths inducing fainting and consequent drowning and the risk of death -The majority of women on antiepileptic drugs have physically normal babies, however evidence suggests increased risk of major congenital malformations in babies of women with epilepsy -The majority of women on antiepileptic drugs have physically normal babies, however evidence suggests increased risk of major congenital malformations in babies of women with epilepsy

Pre-pregnancy care -Preconception advice is essential for women with epilepsy and a review of AED therapy -Preconception advice is essential for women with epilepsy and a review of AED therapy -the gradual withdrawal of AED therapy may be considered prior to pregnancy in order to reduce the risk of congenital malformation in the fetus. -the gradual withdrawal of AED therapy may be considered prior to pregnancy in order to reduce the risk of congenital malformation in the fetus. -Folic acid supplementation (5 mg/day) should be commenced before pregnancy and continued throughout pregnancy to prevent congenital malformation and the development of anaemia. -Folic acid supplementation (5 mg/day) should be commenced before pregnancy and continued throughout pregnancy to prevent congenital malformation and the development of anaemia.

Antenatal care -Pregnancy has no effect on seizure control and most women with epilepsy will remain seizure free -Pregnancy has no effect on seizure control and most women with epilepsy will remain seizure free - Close monitoring of the maternal and fetal condition is required and antenatal care should be provided by a multidisciplinary team which includes a named midwife, obstetrician and a neurologist or physician with a specialist interest in epilepsy in pregnancy - Close monitoring of the maternal and fetal condition is required and antenatal care should be provided by a multidisciplinary team which includes a named midwife, obstetrician and a neurologist or physician with a specialist interest in epilepsy in pregnancy

-u\s at 18 – 22 weeks. -u\s at 18 – 22 weeks. -Epilepsy is not an indication for early induction of labour or elective caesarean section. -Epilepsy is not an indication for early induction of labour or elective caesarean section.

Intrapartum care -labour and birth carry an increased risk for tonic-clonic seizures -labour and birth carry an increased risk for tonic-clonic seizures -Careful observation and monitoring of the maternal and fetal condition by the midwife is required through labour and the early postnatal period. -Careful observation and monitoring of the maternal and fetal condition by the midwife is required through labour and the early postnatal period. - AEDs should be administered as scheduled throughout labour and it is important to prevent the development of possible ‘ trigger ’ situations such as: - AEDs should be administered as scheduled throughout labour and it is important to prevent the development of possible ‘ trigger ’ situations such as:

1- sleep deprivation 1- sleep deprivation 2- hypoglycemia 2- hypoglycemia 3- stress 3- stress 4- hyperventilation 4- hyperventilation 5- anemia 5- anemia -Women with epilepsy should be offered the same choices for pain relief in labour as other women, including epidural analgesia. -Women with epilepsy should be offered the same choices for pain relief in labour as other women, including epidural analgesia.

Postnatal care: -at an increased risk of seizures due to fluctuating hormone levels and sleep disturbance. -at an increased risk of seizures due to fluctuating hormone levels and sleep disturbance. -Safety precautions in the home should be discussed with the woman and her partner. -Safety precautions in the home should be discussed with the woman and her partner. - This will include giving advice about how to minimize risks when feeding, bathing, changing and transporting the baby - This will include giving advice about how to minimize risks when feeding, bathing, changing and transporting the baby

-AEDs cross the placenta freely and decrease production of Vitamin K leading to the risk of Vitamin K deficiency bleeding in the newborn -AEDs cross the placenta freely and decrease production of Vitamin K leading to the risk of Vitamin K deficiency bleeding in the newborn -This can be prevented by routine administration of oral vitamin K (20 mg/day) to the mother from 36 weeks' gestation and to the baby (1 mg i.m.) shortly after birth. -This can be prevented by routine administration of oral vitamin K (20 mg/day) to the mother from 36 weeks' gestation and to the baby (1 mg i.m.) shortly after birth. - Breastfeeding is generally safe. How much AED passes into breast milk must be considered - Breastfeeding is generally safe. How much AED passes into breast milk must be considered

-Some AEDs have a sedative effect, causing drowsy babies less efficient at feeding and gaining weight more slowly. -Some AEDs have a sedative effect, causing drowsy babies less efficient at feeding and gaining weight more slowly. -AED therapy should be reviewed soon after birth by the neurology team. -AED therapy should be reviewed soon after birth by the neurology team. - Future pregnancy plans should be discussed and appropriate contraceptive advice given. - Future pregnancy plans should be discussed and appropriate contraceptive advice given. -All methods of contraception are available to women with epilepsy -All methods of contraception are available to women with epilepsy

- oral contraceptives are less effective with some AEDs. - oral contraceptives are less effective with some AEDs. -Women taking these AEDs will require oral contraceptives with a higher dosage of estrogen -Women taking these AEDs will require oral contraceptives with a higher dosage of estrogen