Transcript Neurological disorders Epilepsy

Neurological disorders
• Epilepsy
• - a common neurological disorder characterized
by two or more seizures,
• - It mainly presents in childhood, although there
is a second peak of incidence in older years and
women of childbearing age
• -Seizures result from a sudden excess of
electricity to the brain
• -seizures can be subcategorized as partial and
generalized
Complications associated with epilepsy are:
• Trauma include tongue biting and head or limb
injury.
• Status epilepticus: a seizure lasting for >30
minutes, or a series of seizures without
regaining consciousness in between.
• Sudden Unexpected Death in Epilepsy (SUDEP)
of which there is no cause found for the sudden
death.
• Maternal death: the risk of sudden maternal
death in pregnancy remains higher in women
with epilepsy than those with other long-term
conditions.
• Treatment is with antiepileptic drugs (AEDs) with
monotherapy (one drug) or polytherapy (two or more)
• -In certain cases surgery or vagus nerve stimulation
might be used
• -Pre-conception care is importance as many AEDs are
associated with folate deficiency and fetal abnormalities.
• - The drug therapy may be changed to monotherapy
after careful counselling about the risks of teratogenicity
to the fetus and folic acid should be prescribed at an
increased dose of 5 mg/day for 12 weeks prior to
conception
• - It is important to involve family and partners, as
they may need to initiate first aid and safety
measures
• -Folic acid of 5 mg/day should be given
throughout the first trimester, and if the woman is
taking sodium valproate (depakein ) this should
continue for all three trimesters.
• - Women taking AEDs will require oral vitamin K
for 4 weeks prior to the baby's birth to decrease
the risk of fetal coagulopathy
• -AEDs levels should be monitored at regular intervals
and the drugs and dosage reviewed by the obstetric
team.
• - The midwife should encourage the woman to comply
with the prescribed medication.
• - avoid bathing alone, and to keep bathroom doors
unlocked in case of a seizure.
• -Screening for fetal anomalies
• - ultrasound scan is offered between 18 and 22 weeks of
pregnancy.
• - discuss a realistic birth plan, and be aware that water
birth is contraindicated on safety grounds
• -The management principles for an epileptic seizure are
the same as for eclampsia
• -Anticonvulsant medication is continued throughout labor
• -If seizures recur, short-acting benzodiazepines are
administered
• -The woman should not be left alone in labor,
• Labor
• Dehydration
• Hyperventilation
• exhaustion should be avoided as they can all trigger a
seizure.
• -differential diagnosis of eclampsia
• -Pethidine is contraindicated as it is metabolized
to norpethidine which can also induce seizure
• - trans-electrical nerve stimulation (TENS) or
epidural should be considered as an alternative.
• The birth can be spontaneously facilitated by the
midwife.
• Following obtaining informed consent from the
woman, vitamin K should be administered to the
baby promptly aher birth to protect against AEDinduced hemorrhagic disease
• 24 hours following the birth the woman has an
increased risk of a seizure and so should remain
in hospital.
• Breastfeeding is encouraged and the medical
team and pharmacist should discuss suitable
AEDs while lactating.
• The baby should be carefully observed and any
concerns reported to the paediatrician
immediately.
• Antiepileptic drugs affect hormonal
contraceptives and alternative contraception
such as barrier methods are recommended
• Advice should be given about safety when
caring for the baby in case of maternal seizure.
• The midwife should encourage the woman to
dress, change and feed the baby on a changing
mat on the floor to prevent falling during a
seizure while attending to the baby.
• It is advisable that the baby is bathed by the
mother in shallow water when someone else is
around to assist if necessary and a carrycot or
baby car seat should be used to carry the baby
up and down stairs
• When parents choose a pram/buggy for
their baby, the midwife should advise them
to ensure that they select one with brakes
that initiate when the handle is released