The epileptic in relation to pregnancy

Abstract

As a result of better therapeutic and social management the epileptic woman has increased opportunities of marriage and epilepsy is likely to become a more frequent complication of pregnancy. The effect of pregnancy on the epileptic is unpredictable. The attacks may increase in number or remain unchanged. Reduction in incidence of fits is often related to better therapy. Epilepsy associated with menstruation usually persists in pregnancy. When attacks first appear in pregnancy (gestational epilepsy) these are likely to be partial or focal in character. The metabolic changes in pregnancy-hydration, hyperventilation, and dilution of calcium, sodium, and magnesium in the serum-favour an increase of fits. The variations in excretion of aldosterone are probably compensatory to fluctuation in sodium intake. Excessive gain in weight and sodium retention may precede the onset of increased fits. A genetic or constitutional factor is important in the appearance of seizures in toxaemia of pregnancy. A persistent epileptic tendency may result. Status epilepticus is a rare but grave complication, especially when occurring in later pregnancy, and has a higher mortality than eclampsia. The onset of status in pregnancy may be the first manifestation of a cerebral dysrhythmia. The epileptic woman should not be discouraged from pregnancy unless the attacks are difficult to control in the non-pregnant state, but there is no excuse for regarding this complication of pregnancy lightly. Antenatal care should be as thorough as in suspected toxaemia of pregnancy. Management of pregnancy consists of suitable anticonvulsants, with dosage corrected for gain in weight. Phenobarbitone in capsule form (“spansule”) may be useful in vomiting of pregnancy. Anaemia should be treated, and macrocytic forms, whether due to pregnancy or anticonvulsants, will require folic acid. Excessive gain in weight should be controlled by diet, restricted salt intake, and rest. If the response is unsatisfactory the use of acetazolamide or ion-exchange resins should be considered. Status epilepticus may require the use of continuous intravenous anticonvulsants, with controlled respiration. Investigation of gestational epilepsy to exclude a neoplasm may be indicated. © 1959, British Medical Journal Publishing Group. All rights reserved.