Mesial temporal lobe epilepsy is one of the commonest indications for epilepsy surgery. Presurgical evaluation for drug resistant epilepsy and identification of appropriate candidates for surgery is essential for optimal seizure freedom. The anatomy of mesial temporal lobe is complex and needs to be understood in the context of the advanced imaging, ictal and interictal Video_EEG monitoring, neuropsychology and psychiatric considerations. The completeness of disconnection of epileptogenic neural networks is paramount and is correlated with the extent of resection of the mesial temporal structures. In the Indian subcontinent, a standard but extended anterior temporal lobectomy is a viable option in view of the diverse socioeconomic, cultural and pathological considerations. The maximum utilization of epilepsy surgery services in this region is also a challenge. There is a need for regional comprehensive epilepsy care teams in a tertiary care academic hospital to form centers of excellence catering to a large population.
Background Epilepsy in pregnancy requires multidisciplinary and specialist input. Method A retrospective audit was conducted of the care of 50 consecutive epileptic women who attended a joint obstetric/neurological antenatal clinic between May 2009 and October 2009. Audit standards were benchmarked according to the National Institute for Health and Clinical Excellence guidelines. Results The average age and parity of the women was 27 years (15–42) and P1 (1–6), respectively. 37 women had grandmal epilepsy, 11 had petit mal and 2 had juvenile myoclonic seizures. There were 5 (10%) general practitioner (GP) referrals for preconceptual counselling and 14/50 (28%) received preconceptual folic acid. 11/50(22%) required no anti-epileptic medications while 32/50 (62%) and 8/50 (16%) of women required monotherapy and polytherapy respectively. The commonest antiepileptic drug administered was lamotrigine in 36% (18/50). 19/50 (38%) experienced increased seizure frequency during pregnancy. No seizures occurred during labour. 1 (2%) patient sustained a postpartum seizure. 29/50 (58%) laboured spontaneously and 15/50 (30%) were induced (10 for obstetric reasons such as preeclamptic toxemia). 1/50 (2%) underwent a medical TOP for fetal abnormality. There were 5/50 elective caesarean sections (C/S), 8/50 emergency C/S and 36/50 (72%) vaginal deliveries. Birth-weight less than the 50th centile occurred in 30/50(60%) of patients; 66% of whom (4/6) and (2/3), were taking sodium valproate and carbamazepine respectively. There were five admissions to NICU. All babies received intramuscular vitamin K. Conclusion This audit highlights the need for improved multidisciplinary care. More referrals or conducting of preconceptual counselling by GPs themselves will enable better compliance of preconceptual folic acid and improve overall patient education.
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