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DESCRIPTION
The nerve cells in the brain produce electrical impulses, which send messages throughout the body. These messages control the body's movements and functions. In a person with a seizure disorder, there is abnormal electrical activity in the brain. This is called a seizure.
Hormones can have an effect on seizure disorders. For women, this includes the sex hormones that control the reproductive system: estrogen and progesterone. Changes in these levels of hormones can make seizures more or less likely. Some women will have changes in seizure patterns when hormone levels shift, such as during pregnancy.
PREGNANCY AND SEIZURE DISORDER
Seizure disorder or epilepsy is characterized by sudden seizures, brief attacks of inappropriate behavior, change in one's state of consciousness or bizarre movements. Seizures (also called convulsions) are a symptoms, not a disease. Seizure disorders are not contagious.
The effect of pregnancy on seizure activity varies, approximately 50% of women show no change in frequency, 40-45 percent experience an increase in frequency, and 5-10 percent have decreased seizure activity. Seizure frequency also can be influenced by hormonal and metabolic changes.
In general, the course of a pregnancy is not affected by the seizure disorder, though it may affect the newborn.
A woman with a history of seizure disorder should seek medical counseling prior to any planned pregnancy. In some cases, if there has been no seizure activity for many years, the anticonvulsant medications may be discontinued before conception. Since most anticonvulsant medications have some effect on the developing fetus, talk to your midwife or health care provider about the risks before conception.
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FREQUENT SIGNS & SYMPTOMS
There are several forms of epileptic seizures (some listed below), each with its own characteristics:
Petit mal (or absence): This mostly affects children. The person stops activity and stares blankly around for a minute or so, unaware of what is happening.
Grand mal: This affects all ages. The person loses consciousness, stiffens, then twitches and jerks uncontrollably. He or she may lose bladder control. The seizure lasts several minutes, and is often followed by deep sleep or mental confusion. Prior to the seizure, the person may have warning signals, a tense feeling, visual disturbances, smelling an odor, or hearing strange noises.
Focal epilepsy: A small part of the body begins twitching uncontrollably. The twitching spreads until it may involve the whole body. The person does not loose consciousness.
Temporal-lobe epilepsy: The person suddenly behaves out of character or inappropriately, such as becoming suddenly violent or angry; laughing for no reason; or making agitated or bizarre body movements, including odd chewing movements.
CAUSES
More than 50 brain disorders, but the cause can be determined in only 25% of cases. Common causes include: brain damage at or before birth; drug or alcohol abuse; chemical poisoning; severe head injury; brain infection; brain tumor or an expanding lesion that compresses the brain (occasionally).
RISK INCREASES WITH
Family history of seizure disorders.
Excess alcohol consumption.
Use of mind-altering drugs.
Exposure to toxic fumes.
Low blood sugar.
History of prior head injury.
Certain medications, which increase seizure risk as a side effect.
PREVENTIVE MEASURES
No specific preventive measures.
EXPECTED OUTCOME
Adequately controlled seizures are not likely to worsen during pregnancy. Mothers-to-be with frequent and uncontrolled seizures before pregnancy will likely experience the same pattern.
A pregnant woman with a seizure disorder who is taking anti-seizure medication has a 90% chance of having a normal baby.
POSSIBLE COMPLICATIONS
Continuing seizures (despite treatment).
Possibility of birth defects in the newborn may be attributable to anticonvulsant medications or to seizure activity. Talk to a genetic counselor about these possibilities prior to conception.
TREATMENT
GENERAL MEASURES
Treatment for epilepsy consists of taking medications specific to the type of seizure. Regular routine prenatal care will be provided with careful monitoring of blood levels of anticonvulsant drugs.
Avoid any circumstance that has triggered a seizure previously.
Make sure the family knows what to do should a seizure occur. Loosen clothing, lay person flat and protect from injury. Although frightening, seizures are rarely harmful in themselves.
Wear a medical alert type bracelet or pendant that shows you have epilepsy in case you have a seizure.
Additional information is available from: Epilepsy Foundation of America
4351 Garden City Dr.
Landover, MD 20785
(800) EFA-1000
http://www.efa.org
MEDICATION
Medications to treat seizure disorders are called anti-epileptic drugs (AEDs), or "anti-seizure" drugs. In most cases, AEDs will prevent seizures all or most of the time. You may have to try more than one AED before you find the right one for you.
Pregnancy can change your pattern of seizures and how your body reacts to AEDs. For this reason, women with seizure disorders should consult their midwife and neurologist if they are pregnant or planning pregnancy. They will need to receive special care before and during pregnancy.
Anti-seizure drugs that are used to treat seizures can affect a growing fetus. AEDs are teratogenic (can cause birth defects). It is best to use the lowest dose of your medicine that controls seizures and lessens the risk of congenital abnormalities. Seizure activity itself can possibly cause birth defects, so it is not recommended to avoid anti-seizure drugs unless seizure activity is known to be controlled without it. If a woman has not had a seizure in 2 or more years, she may be able to slowly stop taking her AED before she tries to become pregnant. Working closely with your neurologist and midwife, the amount of AED may be reduced over several months. As many as half of women will need to go back on the AED after childbirth. You will need to discuss this with your neurologist. Breast-feeding is still feasible for a woman taking anti-seizures.
Folic acid supplements to prevent a folate-deficiency anemia and vitamin D supplements are often recommended. AEDs affect the way the body uses folic acid. Not having enough folic acid has been linked to problems during pregnancy and to certain birth defects. For this reason, all women of childbearing age should take 0.4 mg of folic acid each day - even if they are not planning a pregnancy. Taking this folic acid before and during the first weeks of pregnancy may decrease the risk of these problems.
Vitamin K is usually recommended during late pregnancy and to the newborn at delivery time to prevent a risk of hemorrhage. Anticonvulsant drugs can affect blood clotting factors for the fetus.
ACTIVITY
If seizures are under control, there are usually no restrictions other than those created by the pregnancy. Avoid over-fatigue.
DIET
Follow the recommended pregnancy diet. Don't drink alcohol. It may decrease the effectiveness of your medication and provoke seizures. Be sure to take recommended nutritional supplements and especially folic acid.
FOLIC ACID: THE VITAL VITAMIN
Women should have 0.4 milligrams a day of folic acid before pregnancy and during the first 3 months of pregnancy to reduce the risk of having a baby with a neural tube defect. This is even more important for women with seizure disorders because of their increased risk. Folic acid can be found in many food sources:
- Dark, leafy greens and vegetables (such as spinach, collard and turnip greens, Romaine lettuce, broccoli, and asparagus).
- Whole-grain breads and cereals.
- Citrus fruits and juices (such as strawberries, oranges, and orange juice).
- Organ meats (such as liver).
- Dried peas and beans (such as pinto, black, navy, and lima beans; chickpeas; and black-eyed peas).
RISKS FOR MOTHER
There is a chance that seizures will occur more often during pregnancy. This happens to as many as one third of women, even though they are taking medication. The amount of medication you take may change during your pregnancy. This is because of hormone changes and changes in how the body processes the medication during your pregnancy. The levels of medication should be watched to keep them constant. If levels are too high, it can lead to side effects. If levels are too low, it can lead to seizures. You may have blood tests during pregnancy to check levels of the drug.
Women with seizure disorders are more likely to have other pregnancy problems. This includes high blood pressure as a result of pregnancy. Also, seizures can cause bad falls, resulting in injury.
RISKS FOR BABY
Most babies are born healthy. In all women, the risk of having a baby with a birth defect is 2-3 percent. For women with a seizure disorder, the risk is slightly higher - 6-8 percent. The risk may be related to the medication used, the disorder itself, or both. The direct cause often may not be known. The medication needed to control seizures may cause birth defects. Such defects may include changes in the face, fingers, and nails. Other birth defects linked to seizure disorders include:
Cleft lip or palate (the lip or roof of the mouth is not completely closed).
Heart problems.
Neural tube defects (such as spinal defects).
Babies born to women with a seizure disorder may be at higher risk for certain health problems.
Low birth weight (small baby).
Small head.
Delays in growth and development.
Bleeding (blood-clotting) problems.
Children of women with a seizure disorder are at increased risk for having a seizure disorder themselves. The reason for this is unclear.
AFTER THE BIRTH OF THE BABY
After the baby is born, you may find the need to once again adjust your medication. You will want to choose a method of birth control. Many seizure medications change hormone levels in your body. This can affect how well birth control methods work. The use of some seizure medications may make birth control pills not work as well as they should. You may need to change your method of hormonal birth control. You may want to use a barrier method of birth control (diaphragm, spermicide, or condoms) along with the hormonal method. Talk with your midwife or health care provider about your seizure medication and its affect on your birth control choices.
BREASTFEEDING
Most women with a seizure disorder can breastfeed their babies. Seizure medications are found in small amounts in breast milk, but in most cases this is not enough to affect the baby. Some medications may make babies sleepy or cranky. If this happens, talk with your health care provider and your baby's health care provider about your options. You may wish to use bottle feedings also. You may choose to pump and store your breast milk.
Breastfeeding may disrupt your sleep patterns. This can affect seizure activity. You may wish to have someone else - a partner, a friend, or family member - bottle feed the baby at night with breast milk. Before you stop breastfeeding discuss it with your health care provider and a lactation consultant (such as a Le Leche League consultant).
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has a seizure disorder and is planning to become pregnant.
You are pregnant and have a seizure.
New, unexplained symptoms develop during treatment for seizure disorder. Drugs used in treatment may produce side effects.
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