Most people who go on to be diagnosed with epilepsy will experience their first seizure between the ages of five and twenty years old, though, in fact, a seizure can happen at any age. Many neurologists and neuroscientists are of the opinion that each person’s brain has a threshold above which a fit will be triggered; for people who have epilepsy that threshold can be very low.
Epileptic individuals can experience many seizures which cause changes in behaviour, consciousness and attention. This “threshold” may be lowered because of conditions such as dementia, stroke or metabolic disease particularly in infancy. Trauma to the head resulting in brain injury can also lead to epilepsy as can damage to the brain from infections such as meningitis. However some people are born with differences in their brain that cause them to be more susceptible to seizures.
There are different types of epilepsy and the symptoms usually depend on the part of the brain that is affected by the condition. Not all people with epilepsy have tonic-clonic convulsions – the thrashing fits many people think of when they think of epilepsy and is known as grand mal epilepsy.
An epileptic fit can affect just one part of the body, for example, a facial seizure. People who experience partial seizures variously report being alert and aware of what is happening while others are not. This is one of the differences between partial or focal and complex partial/focal seizures.
Some epileptic individuals have no twitches or convulsions at all: absence seizures are relatively common, especially in childhood, though most people will grow out of them in adulthood. If one observes an absence seizure it is almost as if a person has been put on pause. They are not aware of anything going on around them and are often unaware they have had a seizure when it has passed. This type of epilepsy is known as petit mal epilepsy.
Reducing the number of seizures is usually accomplished using medication, though in the most severe cases, or those not responsive to several types of medication, surgery can be an option.
Epilepsy, Fertility and Preparing for Pregnancy
The chances are, by the time a woman reaches the age at which she is ready to conceive, she will know if she has epilepsy. It is vitally important to speak to your doctor or specialist before you try to conceive as certain anti-convulsant medications can be detrimental to your baby’s development even in early pregnancy. It is worthwhile keeping a diary of seizures before speaking to professionals to assess how well your epilepsy is being managed.
Studies have shown that women who have had no seizures in the nine months before pregnancy are less likely to have seizures during pregnancy. According to the Epilepsy Foundation, over 90% of women with epilepsy have a successful pregnancy so the condition is certainly no bar to motherhood as it was once believed to be.
Like every woman, the chances of conception and a healthy pregnancy are greatly increased by eating healthily, not smoking, reducing or abstaining from alcohol and caffeine and getting regular exercise. Epilepsy itself does not affect fertility however, certain conditions that can be caused by medication or exist alongside epilepsy might such as poly-cystic ovaries or an irregular menstrual cycle. It is also important to be aware that some anti-epileptic drugs can reduce how well oral contraceptives work.
Stress can be a factor in triggering seizures so it is important, as it is for any woman, not to put too much pressure on oneself to achieve a pregnancy quickly. Reduce stress as much as possible and ensure you are getting adequate sleep.
Anti-convulsant Medications and Pregnancy
Taking anti-convulsant medication during pregnancy is associated with an increased risk to the developing foetus of cleft palette and other skeletal abnormalities, congenital heart defects, urinary tract abnormalities, neural tube defects and cognitive deficits ( learning disabilities). All of these will have lifelong repercussions for you and your child, which is why it is so important to seek advice on medication pre-conception.
Medicines containing valproate and its derivatives valproic acid, divalproix sodium and sodium valproate have been shown to increase the risks of cognitive impairment and facial deformities in babies.
Such medicines include:
If you have not had a seizure in more than twenty-four months your doctor or specialist may reduced your medication gradually until you are not taking any at all. However, if your epilepsy is not well managed your doctor may not think it safe to change or reduce your medication. In which case it is important to bear in mind that the side effects of anti-epileptic drugs above affect around 4% to 8% (increased with dose) of pregnancies (compared to 2% for women not taking these drugs) and uncontrolled seizures pose a far greater risk to the developing baby and mother alike.
Epilepsy During Pregnancy
The way in which pregnancy can affect women with epilepsy is highly variable. While many report no change in the number of seizures, those who report an increase in frequency are equalled by those who report the number of seizures they experience decreases. These changes are possibly, in the main, attributable to changes in medication.
Unless you have a prolonged, unusual or large increase in the number of seizures you experience, it is unlikely that whilst pregnant you or your baby will need extra monitoring. If you are taking anti-epileptic drugs, you may be offered a test to check for spina bifida, a neural tube abnormality, or blood tests to check the levels of anti-epileptic drug in your blood.
Women with epilepsy are at greater risk of developing pre-elampsia, a potentially life threatening elevation in blood pressure in the last twenty weeks of pregnancy; vaginal bleeding throughout pregnancy and prolonged bleeding after birth both of which can lead to anaemia; severe morning sickness or hyperemesis; placental abruption, that is the placenta separating from the womb too soon; premature birth and slow progressing or non-progressing labour meaning an increased likelihood of caesarian delivery. Babies born to women with epilepsy are at a greater risk of developing seizures later in life, may have low birth weight and bleeding problems. Sadly, epilepsy increases the risk of having a still birth.
Risks Associated with Seizures During Pregnancy, Labour and Beyond
Many of these risks are the same as those for seizures in general such as injuries from falls, aspiration pneumonia from inhaling saliva into the lungs, stroke and brain damage. Hypoxia, lack of oxygen, can also occur and if prolonged have serious consequences for mother and baby. This is a particular risk during labour though the risk of having a seizure at this time is not significantly increased.
Women with epilepsy are able to take advantage of the same pain relieving medications and interventions as other women. After birth, the levels of anti-epileptic drugs in your blood may be very low and increased medication may be needed for a short time. You may be advised to delay breast feeding or advised not to do so at all. Most women with epilepsy are perfectly able to breast feed but this depends on the type and dose of medication you take and should be discussed with your doctor well in advance of birth.
To reduce the risk of seizures and their complications ensure that people around you know what to do if one should strike and, just as importantly, what is “normal” for you to experience during a seizure. Many people with epilepsy report strange sensations prior to seizures. These auras, as they are known, take many forms but most commonly are strange tastes or aromas. Let others know if you are experiencing any such auras or to look out for indicative changes in your behaviour to ensure you are safe and comfortable should a seizure occur. Wear medical alert jewellery or carry a medical alert card in case of emergencies.
All articles on the blog and website are intended as information only. Please do not consider any of the information provided here as a substitute for medical advice. At all times seek medical advice directly with your own doctor and medical team.