TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Epilepsy          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Dec 30, 2006 12:12 pm    Post subject: Epilepsy If the mother had Epilepsy before but now the disease is controlled withoud drug ,ie there is no risk of ADEs, Is the risk of fetal malformation still higher than general population or the same?! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1862 Location: Nottingham Posted: Sat Dec 30, 2006 12:35 pm    Post subject: Still higher ? double. It is also higher if the father is epileptic similar to diabetes. The child also has an increased risk of epilepsy which increases when both parents are affected. Suggests a genetic predisposition. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Dec 30, 2006 12:52 pm    Post subject: As you open the subject of DM,,, I was thinking that well controlled IDDM are not associated with miscarriage or IUD.....as it is well controlled,,, but now I think it is simillar to epilepsy as you say,, even if controlled, may still cary higher risk of fetal complication....am I right?! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1862 Location: Nottingham Posted: Sat Dec 30, 2006 1:09 pm    Post subject: EMAK wrote: As you open the subject of DM,,, I was thinking that well controlled IDDM are not associated with miscarriage or IUD.....as it is well controlled,,, but now I think it is simillar to epilepsy as you say,, even if controlled, may still cary higher risk of fetal complication....am I right?! You are right. We have discussed this before - see this thread Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Sat Dec 30, 2006 2:08 pm    Post subject: hi, found this on the epilepsy foundation web site.......... GENERAL POPULATION MAJOR MALFORMATIONS 2 to 3 Percent MINOR MALFORMATIONS 5 to 10 Percent FETAL DEATH 2 to 7 Percent WOMEN WITH EPILEPSY MAJOR MALFORMATIONS 4 to 8 Percent MINOR MALFORMATIONS 10 to 15 Percent FETAL DEATH 2 to 14 Percent _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Sat Dec 30, 2006 2:37 pm    Post subject: child of an epileptic .... There is a higher risk for women with epilepsy to have children with the condition than for men with epilepsy. Seizure type and age of onset also affect incidence of epilepsy in the child. The cumulative incidence of epilepsy to age 40 years is 3.6 percent in siblings and 10.6 percent in offspring of index case, compared with 1.7 percent in the general population. Risk of epilepsy is not increased in more distant relatives e.g. nieces and nephews, grandchildren. Risk in monozygotic twins is higher than in dizygotic twins. Risks of epilepsy is approximately twice as high in offspring of affected women as in offspring of affected men. reference ---- Ruth Ottman. Genetic Epidemiology of Epilepsy. Eptdemlologic Reviews. Copyright O 1997 by The Johns Hopkins Unlverstty School of Hygiene and PubBc Health. Vol. 19, No. 1. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1862 Location: Nottingham Posted: Sat Dec 30, 2006 2:52 pm    Post subject: Hi Raj Nice facts as always. So I was right to say the risk was doubled. The chance of the fetus being affected or inheriting the disease is more if the mother is affected than the father and highest when both are affected. Not sure this rule applies to all diseases but I would use these relationships if unsure. It is interesting in that they quote a major abnormality rate of 2-3% in the general population. Many people still quote 1% but I have been promoting 3% for a few years now. I have to share my IVF experience with you... The HFEA quote a 1% risk for background, 2% after IVF, and 3% afrter ICSI. These figures hold regardless even if the couple conceive spontaneously whislt waiting for treatment. The point is we tell couples IVF doubles the risk of abnormalities and ICSI triples it but that the risks relate more to the fact they need treatment than the treatment itself. I tell patients this but always end by saying some people quote a background risk of 3% anyway. Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973 Posted: Sat Dec 30, 2006 3:00 pm    Post subject: Thanks nick. i'm going to remember your 1%, 2%, 3% formula for the next time i talk IVF to a patient. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1862 Location: Nottingham Posted: Sat Dec 30, 2006 3:21 pm    Post subject: I think it is from the HFEA guide on ICSI Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sun Dec 31, 2006 6:24 pm    Post subject: I should Thank you both Nick and Raji many thanks.. 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