Spotlight on Pregnancy and epilepsy

Approximately 20,000 to 25,000 children are born in the United States each year to mothers with epilepsy, and between 0.3% and 0.5% of all pregnancies occur among women with epilepsy. Most of these women need to continue taking medication during pregnancy because uncontrolled convulsive seizures may be harmful to the women as well as to their fetuses. The challenge to physicians is to prescribe a treatment that is effective in controlling seizures but has minimal associated risks.

Overall, 95% of women with epilepsy have uncomplicated pregnancies and deliver normal babies. This rate can be significantly improved with proper management; any serious harm to the baby or mother, particularly if it is avoidable, is too much for the family that is affected. The highest risks for major congenital malformations and adverse cognitive outcomes are associated with polytherapy (mainly combination of valproate and lamotrigine). With monotherapy, the highest risk is found with valproate followed by topiramate. In utero exposure to monotherapy with lamotrigine, carbamazepine, and levetiracetam have a low risk of major congenital malformations, near 2.5%. Furthermore, the concentration of antiepileptic drugs may change significantly during pregnancy and the puerperium, resulting in an increase in seizures (mainly with lamotrigine and oxcarbazepine) or toxicity. Women should be made fully aware of all aspects of antiepileptic drug treatment and be able to make informed decisions.

In this article, Dr. C P Panayiotopoulos of St. Thomas’ Hospital details the various issues that women with epilepsy face before, during, and after pregnancy.

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Spotlight on Pregnancy and stroke

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality. In this article, Dr. Adrian Marchidann of SUNY Health Science Center discusses the etiologies of pregnancy-specific ischemic and hemorrhagic strokes, diagnostic approaches, and therapeutic challenges. The updated article includes the revised definition of preeclampsia and the recommendations for its treatment; new data on the risk of hemorrhage of cavernous hemangioma, arteriovenous malformation, and aneurysm; and the recommendations for antiplatelet and anticoagulation management for secondary stroke prevention during pregnancy and puerperium.

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Spotlight on Pregnancy: neuromuscular complications

Neuromuscular conditions that affect women during pregnancy are diverse. The author examines a broad range of neuromuscular disorders that may complicate pregnancy. The discussion is divided into 2 parts. The first half of the discussion is on disorders that initially present during pregnancy, including Bell palsy, carpal tunnel syndrome, radiculopathy, and lower extremity mononeuropathies. These disorders are felt to be self-limiting; however, data suggest a high rate of residual neuropathies following pregnancy. The second half of the dialogue addresses the ramifications of pregnancy and delivery on preexisting neuromuscular disorders, such as myasthenia gravis and muscular dystrophies.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Pregnancy and stroke

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality among women of childbearing age. In this review, we discuss the etiologies of pregnancy-specific ischemic and hemorrhagic strokes, diagnostic approaches, and therapeutic challenges. The clinical summary has been updated by Dr. Adrian Marchidann of SUNY Downstate Health Science Center in Brooklyn, New York. The most important additions to this update are clarification of the relationship between preeclampsia-related stroke and posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome and hemolysis, and elevated liver enzymes and low platelet syndrome. In addition, the acute treatment of intracerebral hemorrhage and ischemic stroke were updated in light of recently published guidelines and interventional trials.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

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