PakMediNet Discussion Forum : Medicine : Treatment Options for Women with Epilepsy
Treatment Options for Women with Epilepsy
This is in response to the inquiry by Dr Yasir Shirazi. Although the teratogenic side effects of antiepileptic medications are well recognized, the control of seizures during pregnancy is crucial. If the seizures are well controlled on medications, regardless of which one it is best to leave the patient on the same drug. If the patient comes with a plan to get pregnant, folic acid should be initiated and if at all possible monotherapy is preferred. However, no changes should be made which compromizes seizure control. If a patient presents with new onset seizures during pregnancy, the choice can depend on the seizure classification. Since the pharmacokinetics of antiepileptic drugs are altered during pregnancy close follow-ups with drug levels (where available) is often recommended. If a patient is on an enzyme inducer such as carbamazepine, phenobarbital or phenytoin vitamin K supplements are recommended in the last month of pregnancy to minimize the risks of hemorrhagic disease of the new born.
I hope this helps.
Posted by: nizamahmed Posts: 18 :: 04-01-2004 :: | Reply to this Message
Re: Treatment Options for Women with Epilepsy
What are the investigations that should be carried out on a patient who presents with one fit?
Electrolytes, Calcium, Glucose,
CT-Scan brain with contrast
EEG
Is there any other also?
Posted by: docosama Posts: 333 :: 05-01-2004 :: | Reply to this Message
Re: Treatment Options for Women with EpilepsyFurther investigations can be based on the history. Many a times a convulsive syncope is misdiagnosed as an epileptic seizure and if such episodes are recurrent a tilt table test is helpful. In the elderly an ECG or 24 hours holter monitoring can be helpful. Toxicology screen in selected patients can offer some very helpful information.
Posted by: nizamahmed Posts: 18 :: 06-01-2004 :: | Reply to this Message
Re: Treatment Options for Women with Epilepsy
differential diagnosis of a first seizure includes REm behavior disorder or parasomnias,Transient ischemic attack or transient global ischemia of presumably vascular etiology and migraine
amoung seizures there are true epliptiform seizures and physiologic non epileptic seizures.
diagnostic studies include electrolytes, test for porphyrias, hematology studies, renal function test and hematology studies.
LP, CT, EEG and MRI in selected cases
all the above mentioned concerns about antiepileptic medications are reasonable and i agree with mr nizams assessment
Posted by: icumicuccu Posts: 16 :: 19-05-2004 :: | Reply to this Message
Re: Re: Treatment Options for Women with Epilepsy
Being a epileptologist I would not investigate the first seizure , since in most cases it could be the last one.
Multiple seizures need to be investigated.
Imran Khan
Posted by: ikhan700 Posts: 15 :: 02-02-2007 :: | Reply to this Message
Re: Treatment Options for Women with Epilepsy
I would disagree with the notion that the first seizure does not need investigations. If a person has a single unprovoked seizure, there is an approximately 30-40% chance of seizure recurrence over the next 5 years. If a person has 2 unprovoked seizures separated by time there is an approximate 73% chance of seizure recurrence over the next 5 years.Please see the reference
http://content.nejm.org/cgi/content/abstract/338/7/429?andorexacttitleabs=and&search_tab=articles&tocsectionid=Original
A single simple febrile seizure may not necessarily require further investigations. But, an adult presenting with a single unprovoked seizure should be investigated.
Nizam
[Edited by Nizam on 03-02-2007 at 05:40 PM GMT]
Posted by: Nizam Posts: 82 :: 03-02-2007 :: | Reply to this Message