Even a few years back, women with epilepsy were not encouraged to get pregnant. In some countries it is still a misunderstood and extremely stigmatized disorder. Some patients even try to hide their condition. I have seen many women getting divorce, many men losing their jobs and committing suicide due to epilepsy. In developing countries these pictures are much more serious. Still, we are optimistic. Shouldn't we? I like the words Audrey Hepburn once said,
I believe in pink. I believe that laughing is the best calorie burner. I believe in being strong when everything seems to be going wrong. I believe that happy girls are the prettiest girls. I believe that tomorrow is another day, and I believe in miracles.
Epilepsy in pregnancy is a serious issue. Early and regular prenatal care is the most important factor to deliver a healthy baby in epilepsy. In developed countries these facilities are provided in such a wonderful way that more than 90 percent of pregnant women who have epilepsy deliver healthy babies, according to the Epilepsy Foundation.
What is epilepsy?
Epilepsy is a condition in which there is recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain manifest as seizures. It is quite unpredictable and potentially devastating disease that can cause brain injury, and cognitive and psychiatric disabilities.
Many of us may have seizures in abnormal metabolic circumstances like hyponatremia (decrease level of sodium in body), hypoxia (decrease level of oxygen in body) etc. But we would not normally said to have epilepsy. The prevalence of active epilepsy in general population is 1%.
What causes it?
Two thirds of the epilepsy cases are idiopathic (often familial).
Structural causes: head injury, space occupying lesion, stroke.
Other causes: Sarcoidosis, SLE (systemic lupus erythematosus), Tuberous sclerosis etc.
Phases of a seizure
Often the patient or others notice a change in mood or behavior. An aura is part of the seizure of which the patient is aware. This may be of different types. There may be strange feeling in the gut, or an experience like disturbing sense of familiarity or strange smells or flushing lights. After a seizure there may be muscle pain (myalgia), headache, confusion, sore tongue or temporary weakness.
Types of seizure
Partial seizure
Simple partial seizure: Focal motor, sensory (visual, olfactory) or autonomic symptoms. Awareness is intact.
Complex partial seizure: Awareness is lost. Other features are same as simple partial seizure.
Partial seizure with secondary generalization: In some patients with partial seizure, electrical disturbance starts focally and subsequently spreads to the whole brain causing convulsion.
Generalized seizure
No localizing feature like partial seizure is found. There is simultaneous onset of electrical discharge throughout the brain.
Absence seizure (brief pauses of less than 10 seconds, eg suddenly stops talking in mid-sentence. Present in childhood).
Tonic-clonic seizure (limbs stiffen then jerks)
Myoclonic seizure (sudden jerk of limb, face)
Atonic seizure (sudden loss of muscle tone causing fall)
Infantile spasm (associated with tuberous sclerosis)
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