References

Al Wattar BH, Placzek A, Troko J, Pirie AM, Khan KS, McCorry D, Zamora J, Thangaratinam S Variation in the reporting of outcomes among pregnant women with epilepsy: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2015; 195:193-9 https://doi.org/https://doi.org/10.1016/j.ejogrb.2015.10.017

Alarcón G, Valentín ACambridge: Cambridge University Press; 2012

Arman D, Sancak S, Topcuoglu S, Karatekin G New findings in fetal valproate syndrome: hiatal hernia, gastric volvulus and ectopic kidney. J Obstet Gynaecol. 2016; 25:1-2

Artama M, Gissler M, Malm H, Ritvanen A Effects of maternal epilepsy and antiepileptic drug use during pregnancy on perinatal health in offspring: nationwide, retrospective cohort study in Finland. Drug Safety. 2013; 36:(5)359-69 https://doi.org/https://doi.org/10.1007/s40264-013-0052-8

Barnes LM, Uku A, Candelier CK Lamotrigine treatment in pregnancy – be aware of the findings of the 2011 saving mothers lives report. Arch Dis Child Fetal Neonatal Ed. 2012; 97:A42.4-A43 https://doi.org/https://doi.org/10.1136/fetalneonatal-2012-301809.135

Barnett JEH, Gay C Accommodating students with epilepsy or seizure disorders: effective strategies for teachers. Physical Disabilities: Education and Related Services. 2015; 34:(1)1-13 https://doi.org/https://doi.org/10.14434/pders.v34il.13258

Bjørk MH, Veiby G, Engelsen BA, Gilhus NE Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment. Seizure. 2015; 28:39-45 https://doi.org/https://doi.org/10.1016/j.seizure.2015.02.016

Campbell E, Kennedy F, Russell A, Smithson WH, Parsons L, Morrison PJ, Liggan B, Irwin B, Delanty N, Hunt SJ, Craig J, Morrow J Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry. 2014; 85:(9)1029-34 https://doi.org/https://doi.org/10.1136/jnnp-2013-306318

Devinsky O, Vezzani A, Najjar S, De Lanerolle NC, Rogawski MA Glia and epilepsy: excitability and inflammation. Trends Neurosci. 2013; 36:(3)174-84 https://doi.org/https://doi.org/10.1016/j.tins.2012.11.008

Dolk H, Wang H, Loane M, Morris J, Garne E, Addor MC, Arriola L, Bakker M, Barisic I, Doray B, Gatt M, Kallen K, Khoshnood B, Klungsoyr K, Lahesmaa-Korpinen AM, Latos-Bielenska A, Mejnartowicz JP, Nelen V, Neville A, O'Mahony M, Pierini A, Rißmann A, Tucker D, Wellesley D, Wiesel A, de Jong-van den Berg LT Lamotrigine use in pregnancy and risk of orofacial cleft and other congenital anomalies. Neurology. 2016; 86:(18)1716-25 https://doi.org/https://doi.org/10.1212/WNL.0000000000002540

Engel J, Engel JNew York: Oxford University Press; 2014

Gedzelman E, Meador KJ Antiepileptic drugs in women with epilepsy during pregnancy. Ther Adv Drug Saf. 2012; 3:(2)71-87 https://doi.org/https://doi.org/10.1177/2042098611433192

Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, Bare M, Bleck T, Dodson WE, Garrity L, Jagoda A, Lowenstein D, Pellock J, Riviello J, Sloan E, Treiman DM Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16:(1)48-61 https://doi.org/https://doi.org/10.5698/1535-7597-16.1.48

Harden C, Thomas SV, Tomson TChichester: John Wiley & Sons; 2013

Hart LA, Sibai BM Seizures in pregnancy: epilepsy, eclampsia, and stroke. Semin Perinatol. 2013; 37:(4)207-24 https://doi.org/https://doi.org/10.1053/j.semperi.2013.04.001

Hernández-Díaz S, Mittendorf R, Smith CR, Hauser WA, Yerby M, Holmes LB Association between topiramate and zonisamide use during pregnancy and low birth weight. Obstet Gynecol. 2014; 123:(1)21-8 https://doi.org/https://doi.org/10.1097/AOG.0000000000000018

Jackson A, Bromley R, Morrow J, Irwin B, Clayton-Smith J In utero exposure to valproate increases the risk of isolated cleft palate. Arch Dis Child Fetal Neonatal Ed. 2015; 101:(3)F207-11 https://doi.org/https://doi.org/10.1136/archdischild-2015-308278

Kinney MO, Morrow J Epilepsy in pregnancy. BMJ. 2016; 353 https://doi.org/https://doi.org/10.1136/bmj.i2880

Krishnamurthy KB, Morris GLM Folic Acid Supplementation. In: Hazgar M, Harden CL (eds). Switzerland: Springer, Cham; 2016

Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL, French JA Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015; 84:(16)1705-13 https://doi.org/https://doi.org/10.1212/WNL.0000000000001487

MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurology. 2015; 72:(9)981-8 https://doi.org/https://doi.org/10.1001/jamaneurol.2015.1017

Martinez Ferri M, Peña Mayor P, Perez López-Fraile I, Escartin Siquier A, Martin Moro M, Forcadas Berdusan M Comparative study of antiepileptic drug use during pregnancy over a period of 12 years in Spain. Efficacy of the newer antiepileptic drugs lamotrigine, levetiracetam, and oxcarbazepine. Neurologia. 2016; https://doi.org/https://doi.org/10.1016/j.nrl.2016.05.004

MBRRACE-UK. Mothers and Babies: Reducing risk through audits and confidential enquiries across the UK. 2015. http://tinyurl.com/hxq954u (accessed 1 November 2016)

National Institute for Health and Care Excellence. Epilepsies: diagnosis and management. 2016. http://www.nice.org.uk/guidance/cg137 (accessed 1 November 2016)

Ozdemir O, Sari ME, Kurt A, Sakar VS, Atalay CR Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital. Interv Med Appl Sci. 2015; 7:(3)108-13 https://doi.org/https://doi.org/10.1556/1646.7.2015.3.4

Pirie DA, Al Wattar BH, Pirie AM, Houston V, Siddiqua A, Doug M, Bagary M, Greenhill L, Khan KS, McCorry D, Thangaratinam S Effects of monitoring strategies on seizures in pregnant women on lamotrigine: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014; 172:26-31 https://doi.org/https://doi.org/10.1016/j.ejogrb.2013.10.021

Power KN, Gramstad A, Gilhus NE, Engelsen BA Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome. Seizure. 2015; 24:102-6 https://doi.org/https://doi.org/10.1016/j.seizure.2014.09.007

Putta S, Pennell PB Management of epilepsy during pregnancy: evidence-based strategies. Future Neurology. 2015; 10:(2)161-76 https://doi.org/https://doi.org/10.2217/fnl.15.4

Royal College of Obstetricians and Gynaecologists. Epilepsy in Pregnancy: Green-Top Guideline 68. 2016. http://tinyurl.com/zdan4no (accessed 1 November 2016)

Reisinger TL, Newman M, Loring DW, Pennell PB, Meador KJ Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy Behav. 2013; 29:(1)13-8 https://doi.org/https://doi.org/10.1016/j.yebeh.2013.06.026

Ruth DJ, Barnett J Epilepsy in pregnancy: best evidence for care. J Perinat Neonatal Nurs. 2013; 27:(3)217-24 https://doi.org/https://doi.org/10.1097/JPN.0b013e31829d1d29

Saramma PP, Thomas SV Parenting issues of mothers with epilepsy: a case study. Nurs J India. 2007; 98:(3)50-3

The organization of the epilepsies: report of the ILAE Commission on Classification and Terminology. 2014. http://tinyurl.com/zzj63de (accessed 1 November 2016)

Schmidt D The dilemma of treating young women with generalized epilepsy with sodium valproate and how to get out of it. Seizure. 2015; 24:143-4 https://doi.org/https://doi.org/10.1016/j.seizure.2014.10.004

Shahrook S, Hanada N, Sawada K, Ota E, Mori R, Smith CA, Crowther CA, Grant SJ, Dennis CL, Dowswell T Vitamin K supplementation during pregnancy for improving outcomes. Cochrane Database Syst Rev. 2014; https://doi.org/https://doi.org/10.1002/14651858.CD010920

Spray J Seizures: awareness and observation in the ward environment. Br J Nurs. 2015; 24:(19)946-55 https://doi.org/https://doi.org/10.12968/bjon.2015.24.19.946

Tiwari AK, Singh B, Awasthi D, Upadhyaya A, Tomar G Ketotic hyperglycemia with movement disorder. J Emerg Trauma Shock. 2012; 5:(1)90-1 https://doi.org/https://doi.org/10.4103/0974-2700.93095

Tomson T, Battino D, Perucca E Valproic acid after five decades of use in epilepsy: time to reconsider the indications of a time-honoured drug. Lancet Neurol. 2016; https://doi.org/https://doi.org/10.1016/S1474-4422(15)00314-2

Vajda FJ, O'Brien TJ, Graham JE, Lander CM, Eadie MJ Dose dependence of fetal malformations associated with valproate. Neurology. 2013; 81:(11)999-1003 https://doi.org/https://doi.org/10.1212/WNL.0b013e3182a43e81

Veiby G, Daltveit AK, Engelsen BA, Gilhus NE Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol. 2014; 261:(3)579-88 https://doi.org/https://doi.org/10.1007/s00415-013-7239-x

Veiby G, Bjørk M, Engelsen BA, Gilhus NE Epilepsy and recommendations for breastfeeding. Seizure. 2015; 28:57-65 https://doi.org/https://doi.org/10.1016/j.seizure.2015.02.013

Wen X, Meador KJ, Hartzema A Antiepileptic drug use by pregnant women enrolled in Florida Medicaid. Neurology. 2015; 84:(9)944-50 https://doi.org/https://doi.org/10.1212/WNL.0000000000001304

Wlodarczyk BJ, Palacios AM, George TM, Finnell RH Antiepileptic drugs and pregnancy outcomes. Am J Med Genet A. 2012; 158A:(8)2071-90 https://doi.org/https://doi.org/10.1002/ajmg.a.35438

Epilepsy in pregnancy: Pharmacodynamics and pharmacokinetics

02 December 2016

Clinical Practice

02 December 2016

Volume 24 · Issue 12

ISSN (print): 0969-4900

ISSN (online): 2052-4307

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).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

Limited access to our clinical or professional articles
New content and clinical newsletter updates each month

Or continue by

Signing in with your registered email address

Pregnancy

Epilepsy

Sodium valproate

Lamotrigine

Midwifery management