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Neurology (Expert Forum)
Computers anticonvulsants and pregnancy
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Computers anticonvulsants and pregnancy
by Day, Mar 16, 2001 12:00AM
Dear Doctors,
Once up on a time my girlfriend has “absence” in her childhood for one second in the classroom. Now she is 24 years old and she had six grand mal seizures in last three years. All this seizures were similar and she has had unclear “aura” immediately before seizure. Also she has seen “that the picture run to left side and I couldn’t help it”. Three of these seizures were in the time of pregnancy with normal or low 100/50 mm Hg blood pressure. (it is unusual, I think , because during a pregnancy “hormonal environment is rich in progesterone, an agent known to calm seizure activity”, and it is often a time of few seizures. Though she has light signs of nephropathy with some water retention. She has delivered normal baby with light muscle hypertonus that disappeared in some first month.
Last seizure was several days ago. Now several times per day she can fill the dizziness and some time “absence”. Occasionally (very seldom) she also experiences word-finding difficulty. She had an MRI that was normal. On EEG that were signs of epi-activity on the left side in response to visual stimulation. Neurologist proposed to change the job, because it seems harmful for her to look at computer monitor. No medications were recommended.
I’m the physician (nephrologist) and I know some answers for questions you see bellow. Please, answer for them for my girlfriend, not for me…
My questions:
1. Does her need any anticonvulsants?
2. Is it useful for her NEVER see TV or use computer?
3. Are there any computer’s monitors that is safe for epi-patients?
4. Are there maximal and minimal harmful frequency of computer’s monitors (now she uses 60 megahertz monitor)
5. Is pregnancy useful or harmful in this case?
6. Is it possible for her to deliver normal baby if she will take anticonvulsants when she become pregnant?
7. If answer for previous question is positive, what is rate of fetus abnormalities on anticonvulsants during a pregnancy?
8. Are there oral contraceptive most recommended in this case, according the role of hormones?
9. Can she drive a car?
Aleksei
Moscow
Russia
Once up on a time my girlfriend has “absence” in her childhood for one second in the classroom. Now she is 24 years old and she had six grand mal seizures in last three years. All this seizures were similar and she has had unclear “aura” immediately before seizure. Also she has seen “that the picture run to left side and I couldn’t help it”. Three of these seizures were in the time of pregnancy with normal or low 100/50 mm Hg blood pressure. (it is unusual, I think , because during a pregnancy “hormonal environment is rich in progesterone, an agent known to calm seizure activity”, and it is often a time of few seizures. Though she has light signs of nephropathy with some water retention. She has delivered normal baby with light muscle hypertonus that disappeared in some first month.
Last seizure was several days ago. Now several times per day she can fill the dizziness and some time “absence”. Occasionally (very seldom) she also experiences word-finding difficulty. She had an MRI that was normal. On EEG that were signs of epi-activity on the left side in response to visual stimulation. Neurologist proposed to change the job, because it seems harmful for her to look at computer monitor. No medications were recommended.
I’m the physician (nephrologist) and I know some answers for questions you see bellow. Please, answer for them for my girlfriend, not for me…
My questions:
1. Does her need any anticonvulsants?
2. Is it useful for her NEVER see TV or use computer?
3. Are there any computer’s monitors that is safe for epi-patients?
4. Are there maximal and minimal harmful frequency of computer’s monitors (now she uses 60 megahertz monitor)
5. Is pregnancy useful or harmful in this case?
6. Is it possible for her to deliver normal baby if she will take anticonvulsants when she become pregnant?
7. If answer for previous question is positive, what is rate of fetus abnormalities on anticonvulsants during a pregnancy?
8. Are there oral contraceptive most recommended in this case, according the role of hormones?
9. Can she drive a car?
Aleksei
Moscow
Russia
Doctor's Answer
by CCF Neuro[P]-M.D.-RPS, Mar 16, 2001 12:00AM
Dear Dr. Aleksei:
Sorry to hear about your girlfriend. First, it depends what the photoresponse was like. Did the photoresponse continue after the stimulator was shut off- if so this is indicative of a potentially epileptogenic nature. Some studies have indicated that this can also rarely in non-epileptic patients. We consider focal photoparoxysmal responses that are focal is considered abnormal, usually due to cortical dysfunction. If either the focal or generalized response that continues after the stimulus is turned off, then it is considered photosensitive generalized epilepsy.
What your girlfriend needs is a prolonged EEG with sleep deprivation to see if the EEG will show her epilepsy. There may even be a need for video EEG monitoring for prolonged periods. If there is no seizure activity correlated with the EEG then there is something else going on. If she has epilepsy, then likely one of these will show whether she has epilepsy. If she is having seizures, then she needs treatment. Depending on the seizure type (generalized or focal) the proper medication can be given. If she is having seizures, she will most lkely need treatment if she gets pregnant (of course folic acid before trying to getting pregnant). Valproic acid, carbamazepine, and phenytoin are those medications associated with spinal cord defects. As a barbiturate, phenobarbital is also not a good choice for pregancy. Most patients with epilepsy have normal children. Most photoresponsive epilepsy is activated by specific wavelengths and if the TV or computer do not elicit seizure activity (can verify with EEG and TV and computer together) then they should be okay. Since your girlfriend had seizure while pregnant and not, I would not expect Birth control pills to work on her epilepsy.
Sincerely,
CCF Neuro MD
Sorry to hear about your girlfriend. First, it depends what the photoresponse was like. Did the photoresponse continue after the stimulator was shut off- if so this is indicative of a potentially epileptogenic nature. Some studies have indicated that this can also rarely in non-epileptic patients. We consider focal photoparoxysmal responses that are focal is considered abnormal, usually due to cortical dysfunction. If either the focal or generalized response that continues after the stimulus is turned off, then it is considered photosensitive generalized epilepsy.
What your girlfriend needs is a prolonged EEG with sleep deprivation to see if the EEG will show her epilepsy. There may even be a need for video EEG monitoring for prolonged periods. If there is no seizure activity correlated with the EEG then there is something else going on. If she has epilepsy, then likely one of these will show whether she has epilepsy. If she is having seizures, then she needs treatment. Depending on the seizure type (generalized or focal) the proper medication can be given. If she is having seizures, she will most lkely need treatment if she gets pregnant (of course folic acid before trying to getting pregnant). Valproic acid, carbamazepine, and phenytoin are those medications associated with spinal cord defects. As a barbiturate, phenobarbital is also not a good choice for pregancy. Most patients with epilepsy have normal children. Most photoresponsive epilepsy is activated by specific wavelengths and if the TV or computer do not elicit seizure activity (can verify with EEG and TV and computer together) then they should be okay. Since your girlfriend had seizure while pregnant and not, I would not expect Birth control pills to work on her epilepsy.
Sincerely,
CCF Neuro MD
Aleksei Denisow
Moscow
Russia