Epilepsia durante el embarazo

Abstract

Epilepsy a frequent neurological disorder, in approximately fifty million people, half of them affect women, from whom 0.3-0.7% are of childbearing age, according to the ILAE, epilepsy is the presence of two or more unprovoked or reflected crises with more than 24 hours apart, of multifactorial etiology, presenting three categories: genetic, metabolic and idiopathic; in the last most epileptic syndromes are grouped, there are no pathognomonic manifestations, presenting a broad spectrum of symptoms that help categorize within an epileptic syndrome; the diagnosis is clinical and needs detailed information of the patient, eyewitnesses; the diagnostic test is the electroencephalogram, other laboratory tests or image are used to rule out other pathologies. Epilepsy during pregnancy has obstetric importance due to several aspects such as the use of antiepileptic drugs, known to have teratogenic effects and should be used during pregnancy to control the disease and seizures, with this background in a pregnant woman there is a higher rate of complications, such as preeclampsia, vaginal bleeding, caesarean section; in addition, adverse effects on perinatal/neonatal health, such as low birth weight, small for gestational age and prematurity. Approximately 30% of women convulse during pregnancy and 65% occur during the third trimester, in rare cases they have status epilepticus triggered by pregnancy; if so, is due to inadequate concentrations of the medicine, metabolic changes or consequence of physiological changes. The dose adjustment and rotation of anticonvulsant drugs are controversial due to their teratogenicity. Mainly major malformations with valproic acid. In the present clinical case, a 23-year-old patient is studied, with a diagnosis of epilepsy since childhood, during her first unplanned pregnancy, poorly controlled pregnancy since its inception, presenting complications of her illness until the end of her pregnancy by epileptic status.