Epilepsy:

1. Epilepsy:

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

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

4. -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 .

5. • 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: • -An epileptic seizure results from abnormal electrical activity in the brain • -disturbances of sensory, motor and autonomic function. • -These disturbances recur spontaneously and are classified according to the parts of the brain affected.

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

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

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

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

10. 5- environmental factors (strobe lighting, noise) • 6-non-compliance with drug therapy. • 7-hormonal changes at the onset of menstruation may trigger epileptic seizures

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

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

13. -side-effects of(AED). • -drowsiness • -sedation • - nausea and skin rashes. • - 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

14. 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

15. Health education • knowledge of epilepsy in general • • 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 • • an explanation of what happens during a seizure, recognizing status epilepticus, what to do and when to get medical help

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

17. 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

18. Epilepsy increase during pregnancy due to : • non-compliance with the drug regimen • sleep deprivation during pregnancy • 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

19. - 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

20. Pre-pregnancy care • -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. • -Folic acid supplementation (5 mg/day) should be commenced before pregnancy and continued throughout pregnancy to prevent congenital malformation and the development of anaemia .

21. Antenatal care • -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

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

23. Intrapartum care • -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. • - AEDs should be administered as scheduled throughout labour and it is important to prevent the development of possible ‘trigger’ situations such as:

24. 1- sleep deprivation • 2- hypoglycemia • 3- stress • 4- hyperventilation • 5- anemia • -Women with epilepsy should be offered the same choices for pain relief in labour as other women, including epidural analgesia.

25. Postnatal care: • -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. • - This will include giving advice about how to minimize risks when feeding, bathing, changing and transporting the baby

26. -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 . • - Breastfeeding is generally safe. How much AED passes into breast milk must be considered

27. -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 . • - Future pregnancy plans should be discussed and appropriate contraceptive advice given. • -All methods of contraception are available to women with epilepsy

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