Handbook of Genetic Counseling/Fetal Dilantin-Keppra Syndrome

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Fetal Dilantin/Keppra Syndrome

Contracting[edit]

  • Introductions and small talk
  • Acknowledge recent hospitalization
  • Confirm referring physician
  • Assess understanding of the reason for the referral to genetics
  • How much information has your OB given you about the possible effects of taking dilantin/ keppra while pregnant?
  • Despite the increased risk of problems, there is a greater than 90% chance that the baby will be just fine.
  • What concerns or questions do you have that you would like to discuss today?
  • Outline session agenda
    • Medical and family history questions
    • Some of the possible effects that anticonvulsants can have on the pregnancy.
    • Options available to you
    • Discussion of concerns and questions

Elicit Medical History[edit]

  • Pregnancy/neonatal history:
    • LMP: __________
    • EDC: __________
    • Today's gestational age: __________
    • Have you had an ultrasound?
    • Date of ultrasound: __________
    • Results of ultrasound: __________
    • How has the pregnancy been going so far?
    • Seizures last week….any others
    • What medications are you taking? Dilantin and Kepra
      • Amount and frequency of each. When did you start taking each?
    • When did you begin having seizures?
    • What type of seizures do you typically have?
    • Any complications other than the seizures? Infections, colds, exposures etc. (Review and confirm information from the intake form at Bethesda)

Elicit Family History[edit]

(3 generations)

  • Anyone with seizure disorders?
  • Anyone had: multiple SAB, SB, early deaths or babies that required surgery as infants?
  • Anyone born with: birth defects or mental retardation
  • Has anyone had early cancers (dx. <50) or chronic illnesses (heart disease, diabetes)

Discuss possible side effects of taking anticonvulsants during pregnancy[edit]

  • Stress importance of taking medicines- to keep you healthy and therefore the baby healthy
  • Although it's very important for you to take these medications, sometimes seizure medications can have some effects on a developing baby.
  • All pregnancies are at a 3-5% risk of birth defects and mental retardation
  • Women who take anticonvulsants are at a 2-3x increased risk for some specific problems.
  • This doesn't mean that the baby will be born with a problem, it just means that we know that based on your special circumstances, your pregnancy is at an increased risk.
  • Some of the things that we sometimes see in children who have been exposed to dilantin during pregnancy include:
    • Subtle changes in the face..such as the shape of the eyes and nose. These are usually such subtle features that you might not even recognize them
    • Sometimes we see changes in the length of the fingers (slightly shortened) and the size of the fingernails (tiny)
    • But sometimes children can be born with more apparent changes such as a cleft lip/palate or an open spine.
    • Occasionally we see kids who have some delays in development ranging from borderline normal intelligence to mild mental retardation.
    • There is a small risk of other birth defects dealing with the heart and intestinal tract.
  • Keppra: this anticonvulsant hasn't been well studied but we do know that anticonvulsants in general have been associated with an increased risk of birth defects.
  • Some children who have been exposed to anticonvulsants during pregnancy have several of these features and some have none. Just based on your history I can't tell you whether or not your baby will have some or none of these features, but we do have some options that we can offer you.

Options[edit]

  • Level II ultrasound- high resolution to look at the anatomy. ~16 weeks is a good time, but (20+ is ideal).
    • High resolution u/s
    • Done by an experienced technician
    • Better to see more of the developing organs in greater detail
    • Will be looking closely at the features of the baby….spine, heart, brain, shape of the head to make sure that these organs/tissues formed correctly.
    • U/S is good to make us suspicious of some birth defects but it can't tell us everything. We won't know if there is mental deficiency by u/s. Also, u/s is dependent upon cooperation of the baby. Sometimes we just can't get a great view and may not be able to see everything we are looking for.
      • However, a normal ultrasound would certainly be reassuring.

Psychosocial Assessment[edit]

  • Who is living in your home?
  • How are the childcare needs being met?
  • Plans for additional children?
  • Do you have any financial concerns?

Follow-up[edit]

  • Questions?
  • Registry for patients taking anticonvulsants…
  • Do you plan to breast feed the baby? Dilantin is compatible with breast feeding.

Notes[edit]

The information in this outline was last updated in 2002.