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Epilepsy in pregnancy: Pharmacodynamics and pharmacokinetics

02 December 2016
Clinical Practice
02 December 2016
Volume 24 · Issue 12

Abstract

After headache, epilepsy is the second most common neurological disorder encountered in pregnancy. Epilepsy is one of the most common chronic neurological conditions in the world, with an estimated 50 million people affected worldwide. The majority of pregnant women with epilepsy have an uneventful pregnancy, labour and birth. Many pregnant women with epilepsy have well-controlled seizure activity owing to antiepileptic drugs. The use of antiepileptic drugs during pregnancy is challenging because of the need to maintain the balance between the benefits for the woman in seizure control and the risks to the fetus from the teratogenic effects of antiepileptic drugs. Sodium valproate and lamotrigine are currently prescribed for seizure control in pregnancy; midwives should be aware of the effects of these antiepileptic medications on the pregnant woman and her fetus.

Epilepsy is a neurological disorder characterised by recurrent unprovoked seizures (Krumholz et al, 2015). It is one of the most common chronic medical disorders, affecting up to 50 million people worldwide, and may require daily treatment with a known teratogen during pregnancy (Putta and Pennell, 2015). In epilepsy, seizures occur in the absence of electrolyte imbalances, temperature abnormalities, hypoglycaemia, alcohol withdrawal or toxins. Seizures are caused by abnormal discharges of cerebral neurons, and result in the alteration or impairment of consciousness, sensation or motor function (Devinsky et al, 2013). The presentation of seizures is dependent on the location and the number of dysfunctional neurons. Seizures are categorised as either simple focal seizures or complex focal seizures.

Simple focal seizure symptoms relate to the area of the brain encompassing visual, auditory, olfactory, sensory or motor symptoms, while consciousness is preserved. Therefore, olfactory, auditory and visual hallucinations are symptoms of simple focal seizures, as are paraesthesia and motor symptoms (weakness or twitching) (Tiwari et al, 2012; Scheffer et al, 2014). These usually precede complex focal seizures. Complex focal seizure presentation is characterised as impaired consciousness, automatisms and altered behaviour, and a decreased responsiveness (Power et al, 2015).

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Pregnancy
Epilepsy
Sodium valproate
Lamotrigine
Midwifery management