Epilepsy is a disorder than affects clusters of nerve cells, called neurons, in the brain. In a person who suffers from epilepsy, the normal electrical activity is disturbed causing unusual sensations and emotions, and may trigger muscle spasms and convulsions.
In severe cases of epilepsy a loss of consciousness may result. There are many possible causes of epilepsy including an abnormality in brain wiring, a chemical imbalance of nerve signaling, called neurotransmitters, or a combination of factors.
During pregnancy, a person who suffers from epilepsy needs careful monitoring to avoid birth defects and other problems resulting from a lack of oxygen that occurs during a seizure, or from the medications used to control them. Fewer than ten percent (1 in 10) women who have epilepsy will experience problems with their pregnancy or baby. Prior to conception careful counseling is recommended and the coordination of a highly trained and experienced healthcare team including neurologists and epileptologists, is essential during pregnancy.
The occurrence of a seizure is not necessarily a symptom of epilepsy. Most doctors consider epilepsy is present after two or more seizures. The diagnosis is commonly confirmed using an EEGAbbreviation of electroencephalogram. A monitoring device which uses electrodes placed on the head to measure electrical activity produced by the brain cells. The resulting lines, labeled alpha, beta, delta and theta according to the frequencies they record and which range from 2 to 12 cycles per second, are drawn on a sheet of scrolling paper. Brainwave activity can be used to measure differing neurological conditions, psychological states and varying levels of conciousness.
Visit our comprehensive glossary for more pregnancy terms and definitions. and brain scan.
No cause is found for epilepsy in about fifty percent of cases. It is thought that almost anything that affects the brain, including an infection such as meningitis or encephalitis, or physical trauma such as a head injury or insufficient oxygen during childbirth may cause the condition.
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It is thought that some cases of epilepsy may be inherited. Epilepsy can be passed from parent to child, but the incidence among those in the highest risk group is less than ten percent (1 in 10). The incidence is higher among women with the condition than men, but other risk factors include the type, and age of onset of the condition. A child whose mother has epilepsy has a three percent (3 in 100) chance of getting the disease. If the father has epilepsy the risk is no higher than in the general population or about 0.5% - 1% (1 in 100 to 200), but if both parents have epilepsy the risk rises to about five to ten percent (1 - 2 in 20).
Women who suffer from epilepsy are twenty five to thirty three percent (1 in 3 or 4) less likely to have children than those who don't. But it is unclear whether this is the result of reduced fertility or personal choice. In fact it is probably a combination of both factors.
Women who have epilepsy are more likely to suffer from reduced fertility as a result of menstrual irregularities, polycentric ovarian disease and reproductive endocrine disorders. On the other hand, the medications used to control epilepsy, such as carbamazepine, oxcarbazepine, phenytoin, mephobarbital, phenobarbital, primidone, and topiramate, may reduce the effectiveness of hormonal birth control medication by reducing the concentration of estrogenOne of a group of female hormonal steroids that promote secondary sex characteristics.
Created in the ovaries, adrenal cortices, and fetoplacental unit, estrogen is used to prepare the genital tract for fertilization, implantation and nutrition of the embryo.
Estrogen is a key ingredient in oral contraceptives. Estrogens include conjugated estrogen, esterified estrogen, estradiol, estriol and estrone.
Visit our comprehensive glossary for more pregnancy terms and definitions..
During pregnancy, your healthcare providers will carefully monitor the effectiveness and dosage of anti-epileptic drugs, or AEDs. Decreased protein binding of the drugs and increased drug clearance combined with a dramatic increase in plasma volume can reduce the serum concentrations of AEDs in the bloodstream making dosage adjustments necessary.
Despite continued use of anti-epileptic drugs throughout pregnancy, about one quarter to one third (1 in 3 or 4) women will experience an increase in the frequency of seizures during pregnancy. It is thought that a rise in the level of the hormonesA complex chemical substance created in a part or organ of the body. When released it initiates or regulates activity in an organ or group of cells in another part of the body.
Hormones secreted by endocrine glands are transported through the bloodstream to their target organ. The amount of hormone secreted is regulated either by other hormones, by neurotransmitters, or simply when an excess of the organ's activity indicates a need to reduce the amount of the hormone produced.
Other hormones are produced locally by the organs themselves and are common in the digestive tract.
Visit our comprehensive glossary for more pregnancy terms and definitions. estrogenOne of a group of female hormonal steroids that promote secondary sex characteristics.
Created in the ovaries, adrenal cortices, and fetoplacental unit, estrogen is used to prepare the genital tract for fertilization, implantation and nutrition of the embryo.
Estrogen is a key ingredient in oral contraceptives. Estrogens include conjugated estrogen, esterified estrogen, estradiol, estriol and estrone.
Visit our comprehensive glossary for more pregnancy terms and definitions. may increase the incidence of seizures, although progesteroneOne of the two naturally occuring female hormones (the other is estrogen) used to regulate and maintain the pregnancy. Produced first by the corpus luteum in the ovary, production is subsequently taken over by the placenta as it develops. During pregnancy a mother's production of progesterone ten times the level it was prior to conception. Progesterone and estrogen are responsible for giving many mothers a sense of tranquility, shiny hair and glowing skin.
Visit our comprehensive glossary for more pregnancy terms and definitions., which also increases during pregnancy has anti-seizure properties. Because the levels of these two hormonesA complex chemical substance created in a part or organ of the body. When released it initiates or regulates activity in an organ or group of cells in another part of the body.
Hormones secreted by endocrine glands are transported through the bloodstream to their target organ. The amount of hormone secreted is regulated either by other hormones, by neurotransmitters, or simply when an excess of the organ's activity indicates a need to reduce the amount of the hormone produced.
Other hormones are produced locally by the organs themselves and are common in the digestive tract.
Visit our comprehensive glossary for more pregnancy terms and definitions. are changing throughout pregnancy it is difficult for many women to predict the onset of seizures. The decision to discontinue the use of anti-epileptic drugs or change the dose should be made by qualified doctor only, since a rapid change in the concentration of AEDs in the blood can lead to a series of seizures. These may result in intermittent or prolonged unconsciousness called status epilepticus.
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The increase in seizures may also be the result of changes to your normal sleep pattern, and insufficient sleep. Anxiety, and altered eating habits may also contribute to the rise in episodes. If a seizure does occur there is a risk that the baby will suffer trauma or fetal hypoxia as a result of not getting enough oxygen.
There is no increase in the incidence of miscarriage before week twenty among women who suffer from epilepsy during pregnancy. The incidence of stillbirth after week twenty is between two and fourteen percent (1 to 7 in 50) which is almost that of a normal pregnancy (1 to 3.5 in 50).
Women who suffer from epilepsy have an increased risk of hyperemesis gravidarum, vaginal bleeding and are more likely to be anemic.
Perhaps the biggest risk you face postpartum, is having a seizure while attending to your baby. Many doctors recommend that parents sit in a secure and protective area while changing or feeding their babies.
Pregnancy can help you thoroughly understand epilepsy and develop coping strategies to handle the disease. After the baby is born your healthcare providers will closely monitor the levels of anti-epileptic drugs in your body. Over the next few weeks the levels of estrogenOne of a group of female hormonal steroids that promote secondary sex characteristics.
Created in the ovaries, adrenal cortices, and fetoplacental unit, estrogen is used to prepare the genital tract for fertilization, implantation and nutrition of the embryo.
Estrogen is a key ingredient in oral contraceptives. Estrogens include conjugated estrogen, esterified estrogen, estradiol, estriol and estrone.
Visit our comprehensive glossary for more pregnancy terms and definitions. and progesteroneOne of the two naturally occuring female hormones (the other is estrogen) used to regulate and maintain the pregnancy. Produced first by the corpus luteum in the ovary, production is subsequently taken over by the placenta as it develops. During pregnancy a mother's production of progesterone ten times the level it was prior to conception. Progesterone and estrogen are responsible for giving many mothers a sense of tranquility, shiny hair and glowing skin.
Visit our comprehensive glossary for more pregnancy terms and definitions. will stabilize and the dose of your medication may need to be adjusted.
There is a slight risk that the baby may be born with traces of anti-epileptic drugs in their bloodstream. While this does not result in any significant medical problems, your baby may be slightly sedated and experience withdrawal symptoms for a few weeks after delivery. Your doctor will advise you to ensure that your baby is receiving adequate nutrition.
Ninety percent (9 in 10) babies born to mothers with epilepsy have normal, healthy babies with no problems. About four to ten percent (2 - 5 in 50) of babies are born with congenital malformations, which are usually caused by seizures during the course of the pregnancy, a genetic predisposition or the effects of certain anti-epileptic drugs. In fact women increase the risk of congenital abnormalitiesAny abnormality which is present at birth. Also called birth defects, they can arise from genetic inheritance or acquired during gestation through disease or drugs.
Visit our comprehensive glossary for more pregnancy terms and definitions. from two or three percent (2 - 3 in 100) to four or eight percent (4 - 8 in 100) when using AEDs.
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Folic acidA water soluble vitamin with a yellow crystalline construction of the B complex group. Folic acid is necessary for cell growth and reproduction. It works with vitamins B12 and C to breakdown and use proteins, and helps form nucleic acids and heme in hemoglobin.
Folic acid also stimulates the appetite and the production of hydrochloric acid in the digestive tract. It is stored in the liver. Important in pregnancy, natural sources include green leafy vegetables, liver, kidney, asparagus, lima beans, nuts and whole grain cereals. It may also help alleviate menstrual problems. Also known as folacin.
Visit our comprehensive glossary for more pregnancy terms and definitions., or folate, plays an important role in many of the body's chemical reactions and is required to produce the amino acidsAmino acids are substances produced by the baby and used as building blocks in the developing embryo. They are an organic chemical compound composed of one or more basic amino groups and one or more acidic carboxyl groups.
There are more than 100 naturally occuring amino acids, of which 20 form the building blocks of peptides, polypeptides and proteins.
Visit our comprehensive glossary for more pregnancy terms and definitions. that form proteins. Anti-epileptic drugs can decrease the levels of folate, which may cause metabolic dysfunction, malformations or other abnormal fetal development. Your doctor will probably avoid using a combination of drugs, such as Tridione and Paradione, during pregnancy. These drug combinations are more likely to cause major malformations, such as neural tube defectsAny of a group of congenital malformations that involve the skull and the spinal column. Most commonly it involves the failure of the neural tube to close properly during embryonic development.
High levels of alphafetoprotein in the amniotic fluid can reveal potential problems prenatally, and the fetus can be scanned using ultrasound. Immediate surgical repair is required.
Visit our comprehensive glossary for more pregnancy terms and definitions., heart defects or cleft lip and palateA congenital birth defect in which the two sides of the palate fail to fuse during embryonic development. Surgical repair is best performed during the first or second year of life and is performed in stages.
Visit our comprehensive glossary for more pregnancy terms and definitions.. AEDs will probably be avoided if you have a family history of neural tube defectsAny of a group of congenital malformations that involve the skull and the spinal column. Most commonly it involves the failure of the neural tube to close properly during embryonic development.
High levels of alphafetoprotein in the amniotic fluid can reveal potential problems prenatally, and the fetus can be scanned using ultrasound. Immediate surgical repair is required.
Visit our comprehensive glossary for more pregnancy terms and definitions..
Minor abnormalities, which carry no long term medical consequences, are two to three times more likely in women with epilepsy: the incidence can be as high as fifteen percent (5 in 33). These abnormalities include small fingernails, widened eye set, developmental delay and speech abnormalities. Most minor abnormalities cause no serious problems and are of cosmetic concern.
The use of anti-epileptic drugs, including phenobarbital, primidone and phenytoin, may also inhibit the ability of vitamin K to cross the placentaThe placenta is a large disk shaped membrane responsible for providing nourishment to the fetus during pregnancy. It consists of three parts, the fetal part made up from the chorion membrane surrounding the fetus, the maternal part, formed from the decidua basalis layer of the uterine lining, and the intervillous space between the two plates. It is connected to the fetus by the umbilical cord and consists of tissue from both the mother and the embryo.
Its function is complex. It has been described as a simple organ that combines the functions of a kidney-dialysis machine, heart and lung machine and intravenous drip. It consists of enormous numbers of blood vessel branches that permit the exchange of nutrition and oxygen, from the mother's bloodstream to the fetus and the removal of wastes to the mother to be excreted. The placenta's remarkable quality is that it does so without the blood of the mother mixing with that of the baby.
It also is responsible for the production of vital hormones including, estrogen, progesterone, and human chorionic gonadotropin. After birth, the placenta is delivered, and is sometimes referred to as the afterbirth.
Visit our comprehensive glossary for more pregnancy terms and definitions., leading to a prolonged prothrombin and partial thromboplastin times in the newborn. This unique hemorrhagic disease lasts about twenty four hours after delivery, but the risk can be reduced by taking about 10 milligrams daily oral vitamin K supplementation during the last month of pregnancy.
Women who suffer from epilepsy have a higher incidence of premature labor and often require cesarean sections. The risk of eclampsia is increased among women with the condition, and some women who avoided episodes during pregnancy experience them only during labor and delivery.
If you plan to breastfeed your baby you should consult your obstetrician. In most cases you should be able to breastfeed safely, with only trace levels of anti-epileptic drugs remaining in the breast milk. Some drugs may be found in higher quantities, and your doctor will be able to advise you of the health risks you face by breastfeeding.
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The key to having a safe and healthy pregnancy is good planning. Before conceiving get a full neurological evaluation so that you and your doctors better understand your condition. Create a 'pregnancy management team', including an epileptologist or a neurologist who understand epilepsy during pregnancy.
The risk of congenital birth defects can be minimized by switching to a single anti-epileptic drug, and using the lowest dose that can be safely administered. Folic acid supplementation is important for your baby's development, and to counter the effects of the AED.
Make sure you are regularly monitored throughout your pregnancy. Have a thorough ultrasound scan between week sixteen and week eighteen, and ask your doctor to perform alphafetoprotein testing and amniocentesis. And help researchers better understand epilepsy during pregnancy by registering with the North American AED Pregnancy Registry.
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