00:01
Epilepsy and pregnancy.
00:03
All types of adult epilepsy
are potentially teratogenic.
00:09
So when we talk about antiepileptic
drugs, AED stands for antiepileptic drugs
For the most part, think of
it as being teratogenic.
00:17
The couple that I’d walk
you through for sure
included your phenytoin fetal
hydantoin syndrome and valproic acid
and walked you through a
fetal type of hepatotoxicity
and also a condition
known as trigonocephaly.
00:33
Valproic has specifically been
associated with an increased risk of,
please don’t forget,
there might be neural tube
defects including your
encephalocele, anencephaly,
or your spina bifidas.
00:46
Women with epilepsy not on medication
also have a higher incidence of
children with birth defects.
00:52
So in general, it’s a
problem in pregnancy.
00:55
All women of child-bearing
age on antiepileptic drugs
should be put on folate, please, to
prevent the NTDs, neural tube defects.
01:10
The antiepileptic drug levels can
fluctuate widely during pregnancy.
01:15
Especially your phenytoin, but obviously,
you want to try to avoid phenytoin
at all costs in a
pregnant woman.
01:21
Epilepsy may improve during
pregnancy, then worsen post partum.
01:25
Interesting enough,
pregnancy itself could be –
We’ve seen researches
have been taking place
in terms of why seizures or epilepsy
starts minimizing during pregnancy.
01:39
Here’s a condition known
as status epilepticus.
01:42
This would mean that in
less than five minutes,
your patient is going
into crazy seizures.
01:47
So assess and stabilize ABCs.
01:49
In other words, airway,
breathing, and your circulation.
01:52
It must be, must be managed
as being priority.
01:56
You check your ABGs you establish
IV access because it's status.
02:02
Benzodiazepines will be the drug of
choice for managing status epilepticus.
02:08
Your patient is suffering from these severe
seizures for less than five minutes,
it’s actually been dropped in
terms of how quickly it occurs.
02:17
You could have phenytoin or
fosphenytoin if the status continues.
02:21
Prophylactically,
P as in phenytoin and prophylaxis
for status epilepticus
will be the
management of choice.
02:31
But the treatment
of choice in benzo.
02:33
Is that clear?
Please make sure you know that.
02:36
Now,
intubation should always
be an option for you.
02:42
And induce coma with
barbiturates, maybe midazolam,
and so when we say induce coma,
now, you know what that means.
02:49
In other words, you
want to try to –
You are actually trying to –
You’re so worried that your
patient is going to die
because of these such
severe drastic seizures
that apart from intubation,
you’re trying to induce “coma”
with these sedative drugs such as
your benzos or barbiturates and such.
03:11
Propofol and obviously always
EEG is bedside monitoring.
03:18
To summarize your seizures:
Risk factors:
Well, there could be febrile, head,
we walked through a long list
of possible risk factors.
03:28
Preventative medicine: Helmets
So motor cycles, obviously helmets,
your job and, as an answer
choice, would be lifestyle
and to make sure that you
promote helmet-wearing.
03:42
Signs and symptoms:
Well, it depends on the seizure.
03:45
Differential diagnoses: Always
keep in mind these are metabolic.
03:48
Was there electrolyte
issues and such?
Infection, genetic disorder?
Diagnostic workup: Imaging, labs,
lumber puncture, if warranted.
03:56
Remember we talked through a few
populations of adult and children.
04:00
And the treatment, AED stands for
once again antiepileptic drugs.
04:04
We walked through those
tables that are golden.
04:07
And please make sure that
you pay special attention
to those drugs that I have
elaborated on extensively.
04:14
Vagal nerve stimulation, perhaps,
or ketogenic type of diets.