Part 2 book “Handbook of obstetric medicine” has contents: Neurological problems, renal disease, liver disease, gastrointestinal disease, skin disease, haematological problems, human immunodeficiency virus and other infectious diseases, tables. | CHAPTER 9 Neurological problems Epilepsy Migraine and headache Multiple sclerosis (MS) Myasthenia gravis (MG) Myotonic dystrophy Idiopathic (benign) intracranial hypertension Stroke Subarachnoid haemorrhage Cerebral vein thrombosis Posterior reversible encephalopathy syndrome (PRES) Reversible cerebral vasoconstriction syndrome Bell’s palsy Entrapment neuropathies Epilepsy Incidence Epilepsy affects about of women of childbearing age and is the commonest chronic neurological disorder to complicate pregnancy. Clinical features Epilepsy is classified according to the clinical type of seizure or specific electroencephalographic (EEG) features. Many types of epilepsy are characterized by more than one type of seizure. These may be broadly divided into ■■ ■■ ■■ Primary generalized epilepsy (including tonic–clonic seizures, absences and myoclonic jerks) Partial (focal) seizures with or without loss of consciousness or secondary generalisation (complex partial seizures) Temporal lobe seizures, which are a form of partial seizures Temporal lobe seizures are often associated with an aura, a duration of 1 minute or more and confusion after the event. Absences (petit mal) in contrast are normally of short duration (a few seconds), have a rapid onset, rapid recovery and are precipitated by hyperventilation. Absences are associated with 3 Hz spike and wave discharge on the EEG. The clinical features of tonic–clonic seizures due to primary generalized epilepsy and secondary generalized partial seizures may be similar as there may be no identifiable aura associated with the latter. Pointers to a diagnosis of primary generalized epilepsy are myoclonic jerks and photosensitivity. 163 Handbook of Obstetric Medicine Pathogenesis Most cases of epilepsy are idiopathic and no underlying cause is found. About 30% of these patients have a family history of epilepsy. Secondary epilepsy may be encountered in pregnancy in patients who have the following: ■■ ■■ ■■ Previous .
