MoonDragon's Pregnancy Information
PREGNANCY & SEIZURE DISORDER
For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.
Pregnancy & Seizure Disorder Description Signs & Symptoms Seizure Causes Risk Factors For Seizures Preventive Measures Expected Outcome Potential Complications Conventional Medical Treatment Medication Activity Recommendations & Restrictions Diet & Nutrition Maternal Risks Baby Risks Breastfeeding Notify Your Midwife or Health Care Provider Holistic & Herbal Recommendations Nutritional Supplements Recommended Supplement Products
PREGNANCY & SEIZURE DISORDER 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 & 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 percent of women show no change in frequency, 40 to 45 percent experience an increase in frequency, and 5 to 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.
MoonDragon's Health & Wellness Information: Teratogens List
MoonDragon's Health & Wellness: Epilepsy
FREQUENT SIGNS & SYMPTOMS
There are several forms of epileptic seizures (some listed below), each with its own characteristics:
Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure. They produce loss of consciousnenss, either breiefly or for a longer period of time, and are sub-categorized into several major types: generalized tonic clonic, myclonic, absence, and atonic.
Generalized Tonic Clonic Seizures / Grand Mal Seizures: This affects all ages. This is the most common and best known type of generalized seizure. They begin with the person losing consciousness and stiffening of the limbs (the tonic phase), followed by twitches and jerking of the limbs and face uncontrollably (the clonic phase). 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.
Absence Seizures / Petit Mal Seizures: This mostly affects children. This type of seizures are lapses of awareness. The person stops activity and stares blankly around for a minute or so, unaware of what is happening. They begin and end abruptly, lasting only a few seconds. There is no warning and no after-effect. More common in children than adults, absence seizures are frequently so brief that they escape detection; even if the child is experiencing 50 to 100 attacks daily. They may occur for several months before a child is sent for a medical evaluation.
Myoclonic Seizures: These seizures are rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot. People usually think of them as sudden jerks or clumsiness. A variant of the experience, common to many people who do not have epilepsy, is the sudden jerk of a foot during sleep. First aid is usually not needed, however, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.
Atonic Seizures: Atonic seizures produce an abrupt loss of muscle tone. Other names for this type of seizure include drop attacks, astatic or akinetic seizures. They produce head drops, loss of posture, or sudden collapse. Because they are so abrupt, without any warning, and because the people who experience them fall with force, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy. No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the child should be given a thorough medical evaluation.
Infantile Spasms: These are clusters of quick, sudden movements that start between 3 months and two years. If a child is sitting up, the head will fall forward, and the arms will flex forward. If lying down, the knees will be drawn up, with arms and head flexed forward as if the baby is reaching for support. What to Do: No first aid, but a healthcare practitioner should be consulted.
In partial seizures, also known as focal seizures, the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which consciousness is retained); and complex partial seizures (in which consciousness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized. Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations.
KEY THINGS TO REMEMBER ABOUT PARTIAL SEIZURES
Although partial seizures affect different physical, emotional, or sensory functions of the brain, they have some things in common:
In an emergency, health care providers may use drugs to bring a lengthy, non-stop seizure to an end. However, the average person should wait for the seizure to run its course and try to protect the person from harm while consciousness is clouded. People who have been shown how to use a Vagus Nerve Stimulator (VNS) magnet may try to stop a partial seizure in that way. The person having the partial seizure is not dangerous to others. The movements produced by a seizure are almost always too vague, too unorganized and too confused to threaten the safety of anyone else.
- They do not last long. Most last only a minute or two, although people may be confused and need a lot more time afterwards to recover fully.
- They end naturally. Except in rare cases, the brain has its own way of bringing the seizure safely to an end after a minute or two.
- You cannot stop them.
Temporal Lobe Partial Seizures: Focal seizures starting in the temporal lobes are common. The temporal lobes are responsible for many functions. Some examples of these functions are hearing, speech, memory, and emotions. Here are some common symptoms of focal seizures in the temporal lobes.
- Flushing, sweating, going very pale, having a churning feeling in your stomach.
- Seeing things as smaller or bigger than they really are.
- Seeing or hearing something that is not actually happening.
- Smelling non-existent smells.
- Tasting non-existent tastes.
- Feeling frightened, panicky, sad or happy.
- Feeling detached from what is going on around you.
- Feeling sick.
- Having vivid memory 'flashbacks'.
- Having an intense feeling of 'deja vu', when you are convinced you have experienced something before - even when you have not.
- Being unable to recognize things that are very familiar to you - sometimes referred to as 'jamais vu'.
- Chewing, smacking your lips, swallowing or scratching your head.
- Fumbling with your buttons or removing items of your clothing.
- Wandering off, without any awareness of what you are doing, or where you are going.
Frontal Lobe Partial Seizure: Focal seizures starting in the frontal lobes are common. Your frontal lobes are responsible for many different functions. These include movement, emotions, memory, language, and social and sexual behavior. The frontal lobes are also considered to be home to your personality. Not all frontal lobe seizures will be noticed by an onlooker. However, some frontal lobe seizures can look quite dramatic and unusual. Because of this it is common for them to be wrongly diagnosed as something other than epilepsy. Here are some common symptoms of focal seizures in the frontal lobes:
- Turning your head to one side.
- Your arms or hands becoming stiff and drawing upwards.
- Cycling movements of your legs.
- Thrashing of your arms.
- Carrying out strange and complicated body movements.
- Having problems speaking or understanding.
- Experiencing sexual feelings and showing sexual behavior.
- Screaming, swearing or crying out.
- Losing control of your bladder and/or bowels.
Jacksonian seizures are a particular type of frontal lobe seizure. This is usually brief and consists of jerking or trembling movement. These begin in a finger and then slowly march upwards to the whole hand and arm. Afterwards, there could be a short period of muscle weakness.
Todd's paralysis or Todd's paresis may follow a focal seizure, particularly a frontal lobe seizure in some people. This is paralysis, lasting from minutes to hours, in the area of your body that was involved in the seizure.
Parietal Lobes Partial Seizure: Focal seizures starting in the parietal lobes are uncommon. The parietal lobes are responsible for your bodily sensations. Focal seizures in this part of your brain cause strange physical feelings. A tingling or warm feeling down one side of your body is typical. These types of seizures are also known as 'sensory' seizures.
Occipital Lobes Parital Seizure: Focal (partial) seizures starting in the occipital lobes are uncommon. The occipital lobes are responsible for your vision. Focal seizures happening in this part of your brain affect the way you see things. Seeing flashes, or balls of light, or having brief loss of vision, are typical symptoms.
Focal (Partial) Seizures Progressing To Generalized Seizures: Some people have a warning - known as an aura - that they are about to have a tonic-clonic seizure. The warning is usually very brief and, if you have a warning, you tend to have the same warning every time. This warning is, in fact, epileptic activity in a part of your brain (a focal seizure). Once the epileptic activity spreads to both halves of your brain, you have a tonic-clonic seizure. If you have a warning, you tend to have the same warning every time. And the warning is usually brief. The warning can be very useful, as it may give you time to get to a place of safety, or to alert someone else that you are going to have a seizure. Sometimes, however, the epileptic activity spreads to both halves of your brain so quickly that you appear to go straight into a tonic-clonic seizure.
Nonepileptic seizures are episodes that briefly change a person's behavior and often look like epileptic seizures. The person having nonepileptic seizures may have internal sensations that resemble those felt during an epileptic seizure. The difference in these two kinds of episodes is often hard to recognize by just watching the event, even by trained medical personnel. But there is an important difference. Epileptic seizures are caused by abnormal electrical changes in the brain and, in particular, in its outer layer, called the cortex. Nonepileptic seizures are not caused by electrical disruptions in the brain.
STATUS EPILEPTICUS: Most seizures end after a few moments or a few minutes. If seizures are prolonged, or occur in a series, there is an increased risk of status epilepticus. The term literally means a continuous state of seizure.
MoonDragon's Health & Wellness: Epilepsy
More than 50 brain disorders, but the cause can be determined in only 25 percent 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). Causes of seizures are many. The factors that lead to a seizure are often complex and it may not be possible to determine what causes a particular seizure, what causes it to happen at a particular time, or how often seizures occur.
The brain controls how the body moves by sending out small electrical signals through the nerves to the muscles. Seizures, or convulsions, occur when abnormal signals from the brain change the way the body functions. Seizures are different from person to person. Some people have only slight shaking of a hand and do not lose consciousness. Other people may become unconscious and have violent shaking of the entire body. Shaking of the body, either mild or violent, does not always occur with seizures. Some people who have seizures have symptoms before the seizure (auras) or briefly lose touch with their surroundings and appear to stare into space. Although the person is awake, he or she does not respond normally. Afterwards, the person does not remember the episode. Not all body shaking is caused by seizures. Many medical conditions can cause a type of body shaking that usually affects the hands and head (tremors).
A small number of people will have only one seizure during their lifetime. A single seizure usually lasts less than 3 minutes and is not followed by a second seizure. Any normally healthy person can have a single seizure under certain conditions. For instance, a sharp blow to the head may cause a seizure. Having one seizure does not always mean that a serious health problem exists. But if you have a first-time seizure, you should be checked by your health care provider. It is important to rule out a serious illness that may have caused the seizure. Fever seizures (febrile convulsions) are the most common cause of a single seizure, especially in children.
HEALTH PROBLEM CAUSES OF SEIZURES
Epilepsy is a nervous system problem that causes seizures. It can develop at any age.
A seizure can be a symptom of another health problem, such as:
- A rapidly increasing fever (fever seizure).
- An extremely low blood sugar level in a person who has diabetes.
- Damage to the brain from a stroke, brain surgery, or a head injury.
- Problems that have been present since birth (congenital problems).
- Withdrawal from alcohol, prescription medicine, or illegal drugs.
- An infection, such as meningitis or encephalitis.
- A brain tumor or structural defect in the brain, such as an aneurysm.
- Parasitic infections, such as tapeworm or toxoplasmosis.
- Eclampsia is pregnancy-related seizure activity that is usually caused by high blood pressure. It is a life-threatening condition for both a mother and her baby (fetus) because during a seizure, the fetus's oxygen supply is drastically reduced. Eclampsia is more likely to occur after the 20th week of pregnancy. For more information, see Toxemia of Pregnancy / Preeclampsia-Eclampsia.
Nonepileptic seizure (NES), also called pseudoseizure, is a condition that can cause seizure-like activity. NES is characterized by a loss of or change in physical function without a central nervous system problem. The loss or change causes periods of physical activity or inactivity that resemble epileptic seizures. NES is usually related to a mental health problem. The physical symptoms may be caused by emotional conflicts or stress. The symptoms usually appear suddenly and at times of extreme emotional stress.
RISK FACTORS FOR SEIZURES
Dietary risk factors include caffeine and malnutrition. Caffeine in high amounts (500 mg and above) could increase the occurrence of seizures, particularly if it interrupts normal sleep patterns. Malnutrition may increase the risk of seizures. Malnutrition may be the result of poor dietary habits, lack of access to proper nourishment, or fasting. In seizures that are controlled by diet in children, a child may break from the diet on their own.
Other risk factors include:
- 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.
Certain diseases may increase the risk of seizures and those people with various medical conditions may suffer seizures as one of their symptoms. These include:
- Arteriovenous malformation.
- Brain abscess.
- Brain tumor.
- Multiple sclerosis.
- Systemic lupus erythematosus.
Drugs may increase the risk of seizure activity. Some drugs may lower the seizure threshold when used doses intended for recreation. Drugs such as tramadol and methamphetamine have been noted to induce seizures in some, especially when used for long periods of time or in combination with other stimulants. Some drugs may reduce the risk of a seizure occurring. Withdrawals from drugs that act on the GABA receptors may lead to grand-mal seizures in people who have been heavily abusing drugs from the barbiturate or benzodiazepine families. Seizures may be a side effect of certain drugs, though with most, the effect is quite rare, and for most patients, they are safe. These include Aminophylline, Bupivicaine, Bupropion, Butyrophenones, Chlorambucil, Clozapine, Enfluraneketamine, Estrogen, Fentanyl, Insulin, Lidocaine, Meperidine, Pentazocine, Phenothiazines, Prednisone, Procaine, Propoxyphene, Theophylline, Tramadol, and Tricyclic antidepressant. The following antibiotics: Isoniazid, Lindane, Metronidazole, Nalidixic acid, and Penicillin, though Vitamin B-6 taken along with them may prevent seizures. Vitamin B-1 deficiency (Thiamine deficiency) was reported to cause seizures, especially in alcoholics. Vitamin B-12 depletion (Pyridoxine deficiency) was reported to be associated with pyridoxine-dependent seizures. Folic acid in large amounts was considered that might counteract the antiseizure effects of antiepileptic drugs and increase the seizure frequency in some children, although that concern is no longer held by epileptologists. Sudden withdrawal from anticonvulsants may lead to seizures. It is for this reason that if a patient's medication is changed, the patient will be weaned from the medication being discontinued following the start of a new medication. Use of certain street drugs may also lead to seizures. These include amphetamines, cocaine, methylphenidate, and phenylpropanolamine. If treated with the wrong kind medication antiepileptic drugs (AED), seizures may increase, as most AEDs are developed to treat a particular type of seizure.
Alcohol may increase the risk of seizures. There are varying opinions on the likelihood of alcoholic beverages triggering a seizure. Consuming alcohol may temporarily reduce the likelihood of a seizure immediately following consumption. But after the blood alcohol content has dropped, chances may increase. This may occur, even in non-epileptics. Heavy drinking in particular has been shown to possibly have some effect on seizures in epileptics. But studies have not found light drinking to increase the likelihood of having a seizure at all. EEGs taken of patients immediately following light alcohol consumption have not revealed any increase in seizure activity. Consuming alcohol with food is less likely to trigger a seizure than consuming it without. Consuming alcohol while using many anticonvulsants may reduce the likelihood of the medication working properly. In some cases, it may actually trigger a seizure. Depending on the medication, the effects vary.
Alcohol withdrawal is also responsible for seizures. This risk increases with each additional drink from which one has withdrawn.
Missed anticonvulsants may increase the risk of seizures. A missed dose or incorrectly timed dose of an anticonvulsant may be responsible for a breakthrough seizure, even if the person often missed doses in the past, and has not had a seizure as a result. Missed doses are one of the most common reasons for a breakthrough seizure. Even a single missed dose is capable of triggering a seizure in some patients. This is true, even when the patient has not suffered a seizure after previously missing much more of his/her medication. Doubling the next dose does not necessarily help. Missed doses can occur as a result of the patient's forgetfulness, unplanned lack of access to the medication, difficulty in affording the medication, or self-rationing of the medication when one's supply is low, among other causes.
Incorrect medication dosage amount or changing medications during treatment may increase risk of seizures. A patient may be receiving a sub-therapeutic level of the anticonvulsant. Switching medicines may include sudden withdrawal of an anticonvulsant without replacing it at all, or to switch abruptly to another anticonvulsant. In some cases, switching from brand to the generic version of the same medicine may induce a breakthrough seizure. Additionally, in some, gastroenteritis, which causes vomiting and diarrhea, can lead to diminished absorption of anticonvulsants, thereby reducing protection against seizures.
Fever in children may increase seizure risks. In children between the ages of 6 months and 5 years, a fever of 38°C (100.4°F) or higher may lead to a seizure known as a febrile seizure. About 2 to 5 of all children will experience such a seizure during their childhood. In most cases, a febrile seizure will not lead to epilepsy. Approximately 40 percent of children who experience a febrile seizure will have another one. In those with epilepsy, fever can trigger a seizure.
Lights (photosensitive epilepsy) may increase the risk of seizure activity. Flashing light, such as that from a disco ball, can cause seizures in some people. In some epileptics, flickering or flashing lights, such as strobe lights, can be responsible for the onset of a tonic clonic, absence, or myoclonic seizure. This condition is known as photosensitive epilepsy, and in some cases, the seizures can be triggered by activities that are harmless to others, such as watching television or playing video games, or by driving or riding during daylight along a road with spaced trees, thereby simulating the "flashing light" effect. Some people can suffer a seizure as a result of blinking one's own eyes. Contrary to popular belief, this form of epilepsy is relatively uncommon, accounting for just 3 percent of all cases. A routine part of the EEG test involves exposing the patient to flickering lights in order to attempt to induce a seizure, to determine if such lights may be triggering a seizure in the patient, and to be able to read the wavelengths when such a seizure occurs.
Head injury may increase the risk of seizure activity. A severe head injury, such as one suffered in a motor vehicle accident, fall, assault, or sports injury, can result in one or more seizures that can occur immediately after the fact or up to a significant amount of time later. This could be hours, days, or even years following the injury. A brain injury can cause seizure(s) because of the unusual amount of energy that is discharged across of the brain when the injury occurs and thereafter. When there is damage to the temporal lobe of the brain, there is a disruption of the supply of oxygen. The risk of seizure(s) from a closed head injury is about 15 percent. In some cases, a patient who has suffered a head injury is given anticonvulsants, even if no seizures have occurred, as a precaution to prevent them in the future.
Hypoglycemia, also known as low blood sugar, may increase the risk of seizure activity in a diabetic person.
Menstrual cycle, menstruation and hormone fluctuations, as seen during pregnancy, or over-the-counter drugs that are used to treat menstrual symptoms, may increase the risk of seizures in some women. In catamenial epilepsy, seizures become more common during a specific period of the menstrual cycle.
Sleep deprivation may increase the risk of seizures and is the second most common trigger of seizures. In some cases, it has been responsible for the only seizure a person ever suffers. However, the reason for which sleep deprivation can trigger a seizure is unknown. Failure to get enough restorative sleep in some patients may result in a seizure. This is often the patient's only change in routine prior to a seizure. One possible thought is that the amount of sleep one gets affects the amount of electrical activity in one's brain. Patients who are scheduled for an EEG test are asked to deprive themselves of some sleep the night before in order to be able to determine if sleep deprivation may be responsible for seizures. In some cases, patients with epilepsy are advised to sleep 6 to 7 consecutive hours as opposed to broken-up sleep (e.g. 6 hours at night and a 2-hour nap) and to avoid caffeine and sleeping pills in order to prevent seizures.
Stress has been reported a factor and may increase the risk of seizure activity. In one study, emotional stress was reported by 30 to 60 percent prior to their seizures, thereby being the leading cause. This may include stress over hard work one is trying to accomplish, one's obligations in life, worries, emotional problems, frustration, anger, anxiety, or many other problems. Stress may trigger a seizure because it affects the hormone cortisol. Stress can also affect the part of the brain that regulates emotion. Although stress can alter levels of these hormones, it remains unclear whether or not stress can directly result in an increase in seizure frequency.
A breakthrough seizure is an epileptic seizure that occurs despite the use of anticonvulsants that have otherwise successfully prevented seizures in the patient. Breakthrough seizures may be more dangerous than non-breakthrough seizures because they are unexpected by the patient, who may have considered himself or herself free from seizures and therefore, not take any precautions. Breakthrough seizures are more likely with a number of triggers. Often when a breakthrough seizure occurs in a person whose seizures have always been well controlled, there is a new underlying cause to the seizure. Rates of breakthrough seizures vary. Studies have shown the rates of breakthrough seizures ranging from 11 to 37 percent. The treatment for a breakthrough seizure involves measuring the level of the anticonvulsant in the patient's system, and may include increasing the dosage of the existing medication, adding another medication in addition to the existing one, or altogether switching medications. A person with a breakthrough seizure may require hospitalization for a period of time for observation.
Another risk factors may include an acute illness caused by viruses or bacteria that may lead to a seizure, especially when vomiting or diarrhea occur. If a person is on anti-seizure medication, vomiting and diarrhea may reduce the absorption of the anticonvulsant.
There are no specific preventive measures for seizure prevention.
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 percent chance of having a normal baby.
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.
CONVENTIONAL MEDICAL TREATMENT
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
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 a minimum of 0.4 mg (400 mcg) daily, even if they are not planning a pregnancy. For those planning a pregnancy or at risk of becoming pregnant (having unprotected sexual activity), should take 0.8 mg (800 mcg) of folic acid each day. Taking this folic acid before and during the first weeks of pregnancy may decrease the risk of these problems.
Vitamin D is necessary for proper immune function. Aids in Calcium uptake and is necessary for healthy bones and teeth and is also needed for adequate blood levels of insulin. People in northern latitudes or those who do not drink adequate milk, at risk of osteoporosis, have dark skin, live in a cloudy environment, or get out in the sun very much will require more vitamin D-3 supplementation than people who live closer to the equator or sunbathe frequently. Vitamin D is made in our bodies when sunlight converts a chemical in the skin into a usable form of the vitamin. Due to the perils of too much sunlight, concerns have been raised about a decrease in Vitamin D levels particularly in at-risk groups. A deficiency of vitamin D may not only have an impact on bone health, but also immune function, mood and birth weight. Alongside calcium, vitamin D is considered one of the big 3required nutrients together with folic acid and omega 3-fatty acids. Vitamin D deficiency is more common in strict vegetarians (who avoid vitamin D-fortified dairy foods), dark-skinned people, alcoholics, and people suffering intestinal malabsorption disorders such as celiac disease, reduced liver or kidney function.
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.
Folic Acid Supplement Products Vitamin D Supplement Products Vitamin K Supplement Products
ACTIVITY RECOMMENDATIONS & RESTRICTIONS
If seizures are under control, there are usually no restrictions other than those created by the pregnancy. Avoid over-fatigue.
DIET & NUTRITION
Follow the recommended pregnancy diet. Do not drink alcohol. It may decrease the effectiveness of your medication and provoke seizures. Be sure to take recommended nutritional supplements and especially Folic Acid.
See Holistic Recommendations For Epilepsy further down on this page for more information and see this link:
MoonDragon's Health & Wellness: Epilepsy
FOLIC ACID: THE VITAL VITAMIN
Women should have a minimum of 0.4 mg (400 mcg) 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. Folic acid during pregnancy should be raised to 0.8 mg (800 mcg). 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).
Eat cultured, soured milk products like yogurt and kefir. See HomeMade Yogurt for more information.
Include beet greens, chard, eggs, green leafy vegetables, raw cheese, raw milk, raw nuts, seeds, and soybeans in the diet.
Drink fresh "live" juices made from beets, carrots, green beans, green leafy vegetables, peas, red grapes, and seaweed for concentrated nutrients. See Juicing for more information.
Eat small meals, do not drink large quantities of liquids at once, and take 2 tablespoons of Olive Oil daily.
Avoid alcoholic beverages, animal protein, fried foods, artificial sweeteners such as aspartame (NutraSweet, Equal and other products), caffeine, and nicotine. Avoid refined foods and sugar.
Folic Acid Supplement Products Olive Oil Products
HERBAL & HOLISTIC RECOMMENDATIONS
Note: These recommendations are for general population of people with seizure disorders and some recommendations may not be suitable for pregnancy. Consult with your midwife before taking any herbal or nutritional supplement during your pregnancy.
Alfalfa is a good source of needed minerals. Take 2,000 mg daily in capsule or extract form.
Black Cohosh, Hyssop, and Lobelia are beneficial for people with epilepsy because they aid in controlling the central nervous system and have a calming effect. For best results, they should be used on an alternating basis. Caution: Do not use Black Cohosh during pregnancy. It is considered a labor herb and should only be used the last few weeks of your pregnancy under the supervision of your midwife as it is used to help regulate labor contractions.
Avoid the herb Sage. This herb should not be used by anyone with a seizure disorder.
Alfalfa Herbal Products Black Cohosh Herbal Products Hyssop Herbal Products Lobelia Herbal Products
If the bowels do not move each day, before going to bed, take a lemon enema using the juice of 2 Lemons and 2 quarts of water. See Enemas for more information.
Take Epsom Salts bath twice a week.
Work toward self-care. Keep drug dosages as low as possible, and work toward becoming as free from drugs and seizures as possible. The correct diet and nutritional supplements are very important in the control of epilepsy.
Get regular moderate exercise to improve circulation to the brain.
As much as possible, avoid stress and tension. Learn stress management techniques. See Stress for more information.
Stay away from pesticides and other chemicals. See Chemical Poisoning and Chemical Allergies for more information.
Avoid using aluminum cookware. Use glass or stainless steel instead. Aluminum can leach into the food during cooking, and may contribute to seizures. See Aluminum Toxicity for more information.
Consider having a hair analysis to rule out metal toxicity as the cause of seizures. See Hair Analysis for more information.
Lemon Herbal Products Epsom Salts Products
The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments
Dimethylglycine (DMG) As directed on label. A powerful antioxidant increases oxygenation of tissues. L-Carnitine As directed on label. An amino acid required to make protein and deliver essential fatty acids to the cells. Carnitine is depleted by anticonvulsant drugs. Tyrosine 500 mg 3 times daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. Important for proper brain function. Caution: Do not take tyrosine if you are taking an MAO inhibitor drug. Vitamin B Complex 100 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary). Extremely important in the functioning of the central nervous system. Injections (under a health care provider's supervision) may be necessary. Plus Extra
Niacin (Vitamin B-3)
50 mg daily of Niacin. Improves circulation and is helpful for many brain-related disorders. Niacinamide provides Vitamin B-3 (niacin) in a non-flushing form. And
Pantothenic Acid (Vitamin B-5)
500 mg daily. An anti-stress vitamin. Plus Extra
Vitamin B-6 (Pyridoxine)
100 to 600 mg 3 times daily, under the supervision of a health care professional. Needed for normal brain functioning. And
400 mcg daily. If you are taking anticonvulsants, do not exceed 400 mg daily from all sources. A brain food vital for the health of the nervous system. Vitamin B-12 200 mcg twice daily. Involved in maintenance of the myelin sheaths that cover and protect nerve endings. a brain food vital for the health of the nervous system. The anti-stress vitamin. Magnesium 700 mg daily, in divided doses. Take between meals, on an empty stomach, with Apple Cider Vinegar or Betaine HCl. Needed to calm the nervous system and muscle spasms. Use magnesium chloride form. Selenium As directed on label. If you are pregnant, do not exceed 40 mcg daily. Low selenium levels result in a deficiency of glutathione peroxidase, an enzyme that detoxifies peroxides in the cells. Caution: Do not take supplemental selenium if you are pregnant or have heart, kidney, or liver disease. Taurine 500 mg each 3 times daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. Important for proper brain function. Caution: Do not take tyrosine if you are taking an MAO inhibitor drug.
Calcium 1,500 mg daily. Important in normal nerve impulse transmission. Liquid Kyolic
As a dietary supplement, take 1/4 to 1/2 teaspoon, or 30 to 60 drops (one or two filled capsules) with a meal twice daily. Increases energy and acts as an antioxidant. Zinc 50 to 80 mg daily. Do not exceed 100 mg daily from all supplements. Protects the brain cells. Use zinc gluconate lozenges or OptiZinc for best absorption.
Coenzyme Q-10 130 mg daily. Improves brain oxygenation. Coenzyme A As directed on label. Works well with CoQ10 for best results. Facilitates the repair of RNA and DNA. Supports immune system's detoxification of many dangerous substances. Can streamline metabolism, ease depression and fatigue, and increase energy. Oxy-5000 Forte
As directed on label. A potent nutritional antioxidant for health and stress. Destroys free radicals. Quercetin
As directed on label. A flavonoid with anti-inflammatory and antioxidant properties. More powerful than vitamin C.
Chromium Picolinate 200 mcg daily. Important in maintaining stable cerebral glucose metabolism. Improves insulin's efficiency, which lowers blood sugar. Aids in mobilizing fats for energy. Caution: If you have diabetes, consult with your health care provider before taikng any supplement containing chromium. Kelp 1,000 to 1,500 mg daily. For mineral balance. Alfalfa 2,000 mg daily in capsule or extract form. For necessary mineral balance. Melatonin 2 to 3 mg daily for adults. 1 mg or less daily for children, taken 2 hours or less before bedtime. If necessary, gradually increase the dosage until an effective level is reached. Helpful if symptoms include insomnia. Multi ProteolyticEnzymes As directed on label. Multi-Enzymes - Take before meals. Proteolytic Enzymes - Take between meals. Multi-Enzymes aids digestion, helping to make needed nutrients available. Proteolytic Enzymes aids in healing if inflammation is the cause of seizures. Raw Thymus Glandular As directed on labor. Important in proper brain function. See Gland Therapy for more information. And
As directed on label. Important in proper brain function. See Gland Therapy for more information. Vitamin A 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Vitamin A is a powerful antioxidant and detoxifier that aids in protecting brain function. Plus
Carotenoid Complex (Betatene)
25,000 IU daily.
As directed on label.
An antioxidant and precursor of vitamin A. Needed by all cells for repair and rebuilding. Vitamin C
2,000 to 7,000 mg daily, in divided doses. Vital to functioning of the adrenal glands, which are the anti-stress glands. A potent antioxidant. Essential in immune function and tissue repair. Deficiency may lead to vascular problems in people with diabetes. Vitamin E Start with 200 IU daily and gradually increase to 1,600 IU daily. Aids in circulation and immunity. Compensates for anticonvulsant-induced vitamin depletion. Emulsion form is recommended for easier assimilation and greater safety at high doses. Use d-alpha-tocopherol.
PREGNANCY & SEIZURE 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.
PREGNANCY & SEIZURE RISKS FOR BABY
Most babies are born healthy. In all women, the risk of having a baby with a birth defect is 2 to 3 percent. For women with a seizure disorder, the risk is slightly higher - 6 to 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).
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.
MoonDragon's Pregnancy Information: Spina Bifida
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.
MoonDragon's Womens Health: Contraception Methods Compared
MoonDragon's Womens Health: Contraception: Oral Birth Control (The Pill)
MoonDragon's Womens Health: Contraception: Diaphragm
MoonDragon's Womens Health: Contraception: Spermicides
MoonDragon's Womens Health: Contraception: Male Condom
MoonDragon's Womens Health: Contraception: Female Condom
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. If you are pregnant and have a seizure. If new, unexplained symptoms develop during treatment for seizure disorder. Drugs used in treatment may produce side effects.
MoonDragon's Health & Wellness: Epilepsy
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Information Index
MoonDragon's Womens Health Pregnancy Information Index
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Information Index
QUALITY SUPPLIES & PRODUCTS
EPILEPSY & SEIZURE DISORDERS SUPPLEMENT PRODUCTS
Information, supplements and products for Epilepsy, a neurological disorder that occurs when there is excessive electrical impulses in the brain. Included are supplements for depression, anxiety, stress and mood balance. These supplements are for general use for seizure disorders and not all may be recommended for use during pregnancy. Consult with your midwife or health care provider before using supplements during pregnancy.
Alfalfa Herbal Products Apple Cider Vinegar Beta Carotene Products Black Cohosh Herbal Products Black Currant Herbal Products Blue Cohosh Herbal Products Blue Vervain Herbal Products Calcium Supplement Products Carnitine Amino Acid Supplement Products Carotene Complex Products Chamomile Herbal Products Choline Supplement Products Chromium Picolinate Supplement Products Coenzyme A Supplement Products Coenzyme Q-10 Supplement Products Colon Cleanse Products Depression Supplement Products DHA Omega Supplement Products DMAE (Dimethylaminoethanol) Products DMG (Dimethylglycine) Supplement Products Elm Herbal Products Emotional Balance Products Epsom Salts Products 5-HTP Supplement Products Flaxseed Herbal Oil Products Folic Acid (Vitamin B-9) Supplement Products GABA Supplement Products #gerovital">Gerovital Supplement Products Ginger Herbal Products Ginkgo Biloba Herbal Products Grapeseed Herbal Products Holy Basil Herbal Products Hops Herbal Products Hydrochloric Acid (Betaine HCl) Hyssop Herbal Products Inositol Supplement Products Kava Kava Herbal Products Kelp Herbal Products Lecithin Supplement Products Lemon Balm Herbal Products Lithium Supplement Products Liquid Kyolic Garlic Supplement Products Lobelia Herbal Products Magnesium Supplement Products
Melatonin Supplement Products Mental Clarity Supplement Products Mood Supplement Products Multienzyme Supplement Products Multimineral Supplement Products Multivitamin Supplement Products NADH Supplement Products Natural Calm Remedy Products Noni Herbal Products Oatstraw Herbal Products Olive Herbal Oil Products Oxy-5000 Forte Supplement Products #patchoulioil">Patchouli Essential Oil Products Propolis Bee Supplement Products Quercetin Supplement Products Relaxing & Calming Products Relaxing Herbal Tea Products Rooibos Herbal Products Rose Absolute Essential Oil Products Rosemary Herbal Products Royal Jelly Bee Products Salmon Fish Oil Supplement Products SAM-e Supplement Products Selenium Supplement Products Skullcap Herbal Products Stevia Herbal Products St. John's Wort Herbal Products Sutherlandia Herbal Products Taurine Amino Acid Supplement Products Theanine Supplement Products Thymus Glandular Products Thyroid Glandular Products Tyrosine Amino Acid Supplement Products Valerian Herbal Products Vitamin A Supplement Products Vitamin B-1 Supplement Products Vitamin B-3 Supplement Products Vitamin B-5 Supplement Products Vitamin B-6 Supplement Products Vitamin B-12 Supplement Products Vitamin B-Complex Products Vitamin C Supplement Products Vitamin D Supplement Products Vitamin K Supplement Products Zinc Supplement Products
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
MOONDRAGON'S MERCHANT VENDORS & PRODUCTS
Educational materials and health products are available through Amazon.com.
Use the search box provided below to search for a particular item.
MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.