I’m 25 years old and epileptic. I have always struggled with managing my seizures by keeping calm, having enough rest, working under normal conditions and feeding well. However, I’m currently expecting my first born baby and I have fears that with the stress and fatigue that come with pregnancy, I might experience more occurrences of seizures which I’m afraid might harm the baby. Is there a routine I can follow to control them? What medication should I take in case seizures persist? Angel Dear Angel I understand your problem. Epilepsy is a condition causing physical sickness as well as mental anguish. You have not specified whether the epilepsy started recently after a fever, head trauma or any other sickness. In such cases it is treatable if the underlying cause is treated. Primary epilepsy, the one which occurs without any apparent underlying cause needs life-long precautions and treatment. Moreover there is increased risk of repeated injuries, plus side effects of long term anti-epileptic medication. During pregnancy, epilepsy becomes more problematic. Due to physiological changes occurring during pregnancy, metabolism of anti epileptic drugs is altered rendering them less effective. The susceptibility to seizures increases during pregnancy. Hence one has to take higher doses of drugs to control convulsions, increasing risk of adverse effects. As such, women suffering from epilepsy do not conceive readily due to multiple factors. Pregnant women form 0.5 per cent cases of epilepsy. When one conceives, due to seizures, there is a risk of abortions, fetal hypoxia and intrauterine deaths. If the mother has taken Vitamin K prior to delivery during gestation, the new born baby carries an increased risk of bleeding. The child born carries a risk of neurological defects and also retarded mental state. If one has primary epilepsy, there may be hereditary factors involved and the child also carries a risk of having epilepsy as he grows up. No anti epileptic medicine is entirely safe for pregnancy and all have adverse effects on the fetus. But one cannot do without it. Hence the advantages of medical therapy should be weighed against the risk of adverse effects to the mother and baby. Carbamazepine, dilantin sodium are some of the drugs which can be continued and are available here. The aim should be to take medicines in the lowest dose possible. It is good to strictly follow preventive measures. These include avoiding anything which can be exciting for the brain thus precipitating convulsion. One should avoid crowded noisy places, watching television or listening to the radio for long hours continuously. Caution is also needed if one is with many friends together say in a party or picnic. Climbing up to heights is also not recommended. In short it can be said, staying calm in a quiet atmosphere is good. Regular monitoring of pregnancy with clinical and ultrasound examination to check progress and health of baby is useful to prevent problems later on. It is advisable to take supplements of folic acid during pregnancy to counteract folate deficiency and subsequent anemia due to anti epileptic drugs. A woman with epilepsy can deliver normally under surveillance. But if necessary, the obstetrician can plan an elective caesarean section after the fetus becomes viable. Dr. Rachna is a specialist in internal medicine at Ruhengeri Hopsital
