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Mastitis

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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Epilepsy

epilepsyEpilepsy should not be viewed as a restriction on becoming a parent

What is epilepsy?

Epilepsy, also known as a seizure disorder, is a neurological condition that affects the nervous system. Epilepsy causes recurrent seizures or convulsions, during which electrical signals in the brain are disturbed. Epileptic seizures can be divided into 2 main groups, depending on how much of the brain is affected. Generalized seizures, affect all areas of the brain simultaneously. There are two main types of generalized seizures- grand mal (a fit followed by sleepiness) and petit mal (the absence of seizures) seizures. Seizures that only affect one part of the brain are known as partial seizures. Epilepsy is generally diagnosed after a person has had at least 2 seizures that are not the result of a known medical condition, such as alcohol withdrawal or extremely low blood pressure. In most cases, the cause of the seizures is unknown; but epilepsy can be due to a brain injury or a familial tendency.

Epilepsy & pregnancy:

The combination of epilepsy and pregnancy may seem risky and many years ago, epileptic women were discouraged from falling pregnant, but today, this is no longer the case. According to the Epilepsy Foundation, more than 90% of pregnant women who have epilepsy deliver healthy babies. However, women with epilepsy have a higher risk of developing complications during pregnancy and labour.

Epilepsy & Fertility:

Consult your doctor if you are epileptic and planning a pregnancy. Some women with epilepsy have irregular menstrual cycles or only have periods very rarely, as well as other gynaecological problems, that may make conception more difficult. Medication may also play a role in this regard. Some medications used to control seizures may contribute to infertility because they affect the hormones that control your menstrual cycle. In some cases, a woman's period may arrive earlier or later than expected. The average menstrual cycle is between 25-35 days, it is unusual to have a cycle of less than 25 days or more than 35 days. Studies also suggest that another possible cause of irregular menstrual cycles, Polycystic ovary syndrome (PCOS), is more common in women with temporal lobe epilepsy and those who take the anti-epileptic drug sodium valproate (Epilim), especially from a young age. However, the syndrome often improves once a woman stops taking Epilim. If you are concerned about PCOS, do not stop taking your anti-epileptic medication without your doctor’s advice as you may run the risk of having more seizures. In general, epileptic women tend to have a 25-33% lower fertility rate than average.

Epilepsy & unplanned pregnancy:

Some women on certain anti-epileptic drugs (AEDs) may experience failure of hormonal birth control methods. Carbamazepine, oxcarbazepine, phenytoin, barbiturates and topiramate, may lower concentrations of estrogen, thus reducing the effectiveness of the hormonal contraceptive.

If you fall pregnant unexpectedly, consult an obstetrician who will discuss and plan your care during pregnancy. You may be referred to a neurologist, for assistance in controlling your condition during pregnancy. If there is a family history of epilepsy in yours or your husband’s family, your care team will discuss the possibility of your baby inheriting the condition. Begin supplementing with folic acid immediately, to help protect your baby against the effects of anti-epileptic drugs.

How epilepsy affects pregnancy:

It is crucial for expectant moms with epilepsy to get plenty of sleep, the best possible nutrition, and to maintain adequate fluid levels.

Despite a balanced diet, women with epilepsy are more prone to developing folate-deficiency anaemia. Supplementation with folic acid (a minimum dose of 0.4mg daily), will reduce this risk significantly. However, in some women it may increase the frequency of seizures. Ideally, supplementation should be started 3 months before conception, or immediately on discovering that you are pregnant.

Some medications interfere with the metabolism of vitamin D, so supplementation of this vitamin may be recommended.

Babies of epileptic mother's have a slightly higher risk of hemorrhage. As a result, a vitamin K supplement may be prescribed for expectant moms during the last 4 weeks of pregnancy, or the baby will be given an injection of the vitamin at birth.

What does epilepsy mean for my baby?

Any medication you are taking while pregnant is potentially harmful to your baby.

Babies born to mothers, who have epilepsy, have a slightly higher risk of developing seizures later in life.

Other problems may include minor defects, involving the baby’s appearance, such as wide-set eyes or a short upper lip. The incidence of these anomalies in infants born to mothers with epilepsy is approximately 15%.

Developmental delays are also a possibility.

Medication issues:

To minimize risks to your baby's development, it is sometimes possible to switch to safer drugs, to use the lowest but still effective dose of a medication, or to alter the way in which the drugs are given. In general, taking a single less risky drug appears to cause fewer problems during pregnancy, than multi-drug therapy. Drugs may also be given in slow release preparations. If possible, make these changes in drug therapy before rather than during pregnancy and only initiate them with the advice of a professional who has specialist knowledge in the treatment of epilepsy. This may include your obstetrician or neurologist. Never alter drug treatment or stop your medication without specialist advice.

Managing epilepsy during pregnancy:

  • Strictly comply with your doctor’s prescription, regarding your medication. If you have been seizure free for 2 years or more, your doctor may slowly decrease and eventually stop your seizure medication, before you become pregnant or while you are pregnant.
  • Avoid anything that may trigger or has triggered a seizure in the past, such as flashing lights.
  • Limit caffeine intake.
  • Take prenatal vitamins.
  • Learn relaxation techniques in order to manage stress, which may trigger seizures.
  • Eat meals at regular times.
  • Exercise regularly.
  • Take prenatal vitamin supplements and folic acid. Your doctor may prescribe a type of prenatal vitamin with higher doses of folic acid because anti-seizure medication can change the way your body absorbs folic acid.

What to expect during pregnancy:

Your doctor will see you often during the course of your pregnancy. Frequent blood tests will be taken to measure the levels of your anti-epileptic medication in your blood. It is common for doctors to adjust the dosage of these drugs during the course of your pregnancy. Several ultrasound exams, called sonograms will be performed. Your doctor may also wish to do an amniocentesis. This procedure involves the removal of a small amount of fluid from your uterus. This fluid gives your doctor an indication of the health of your unborn child. All these precautions, allow your doctor to monitor your pregnancy and your unborn baby's development.

Complications:

Women with epilepsy have a higher risk of pregnancy related complications than women who don't have epilepsy. However, it must be borne in mind that pregnancy affects each woman with pregnancy differently and some women actually experience fewer seizures than normal.

Giving birth:

Labour and delivery are generally not more complicated, if a mother has epilepsy. It is essential that anti-convulsant medication continues to be administered during labour, to minimize the risk of a seizure during delivery. You can ask your partner to remind you to take your medication at the correct time during labour. Epidural anaesthesia can be used to ease the pain. However, it is recommended that you give birth in a maternity team unit in a hospital, so that your doctor is available to you and your baby if necessary. Since only 1 or 2% of women with epilepsy have a seizure during labour, natural birth is safe and possible if this is your preference, provided that you and your baby are healthy. If you do have a seizure during labour, it may be stopped with intravenous medication. If the seizure is prolonged or your labour is not progressing normally, your doctor may deliver the baby by C-section.

Women with epilepsy can have pain relief during labour, but there are some important factors to keep in mind:

Breathing exercises and gas can be used to help you manage pain during labour. However, women with epilepsy need to caution against over-breathing because in some people over-breathing can trigger seizures.

If you decide to have an epidural, tell your anaesthetist that you have epilepsy, what medication you are on and the dosage.

You may be advised not to use pethadine for pain relief because high doses of this drug have been known to trigger seizures in some people.

TENS machines are often used during labour to ease the pain. These are perfectly safe if you have epilepsy.

Breastfeeding:

Breastfeeding should not be problematic, since most epilepsy medications pass into the breast milk in such low doses, that they do not affect a nursing baby. Always check with your baby's paediatrician, to make sure the specific medications you are taking, are safe to use while breastfeeding. If your baby becomes abnormally sleepy following a feed, report to your doctor immediately - a change in medication may be required.

Conclusion:

Pregnancy is challenging no matter whom experiences it and epilepsy brings special issues for women, particularly during the reproductive years. It must be borne in mind that; epilepsy affects women differently, during each of their life stages - their hormonal and menstrual cycles, pregnancy and menopause. Besides concerns with proper nutrition, exercise and medical care; expectant mothers' with epilepsy have to concern themselves with medication related problems, flare-ups, and falls during seizures. However, with proper prenatal care, most women with epilepsy can and do have normal pregnancies. There are "few other joys equal to those of parenthood, and epilepsy should not be viewed as a restriction on becoming a parent".

References:

http://www.epilepsy.com

http://www.mayoclinic.com

http://www.epilepsy.org.uk

http://www.epilepsyfoundation.org

http://www.familydctor.org

http://www.nhs.uk

http://www.authorsden.com

Dr. Cooper, C. (ed.). (2003). Johnson's mother & baby: Pregnancy, birth and the first three months of your baby's life. Dorling Kindersley: Great Britain.

Dr. Stoppard, M. (2005). family health guide: The essential home reference for a lifetime of good health. Dorling Kindersley: Great Britain.

Murkoff, H.E., Eisenberg, A. & Hathaway, S.E.. (2002). What to Expect: when you're expecting. Pocket Books: UK.