Pregnancy

Background: The UK Medicines and Healthcare products Regulatory Agency (MHRA) published guidelines restricting the use of sodium valproate in women of childbearing age unless they consented to the pregnancy prevention programme (PPP), receiving counselling by an epilepsy specialist, or meeting exclusion criteria.

Method: We contacted every woman of childbearing age on valproate for epilepsy in NHS Tayside (122).

Diagnosis of inherited arrhythmia syndromes, including long-QT syndrome (LQTS), is challenging; however, early detection and initiation of therapies can reduce otherwise high rates of mortality.

Two months following the birth of her first child a previously well 21-year-old female experienced four episodes of transient loss of consciousness (TLOC). 

The history was atypical for seizures but a video electroencephalogram (EEG) captured an episode with abnormal bifrontal epileptic discharge. She was commenced on levetiracetam. 

Paleopathologists have identified osteoporosis in ancient skeletons and modern physicians and scientists have identified risk factors for osteoporosis today, but they are not clearly linked, making it more difficult to clarify the causes of osteoporosis in the past. The evidence for osteoporosis in the remote past, its causes, and the management of this disease is reviewed in the light of evolving and improving diagnostic modalities, more precise definitions, and the recent rapid expansion of therapeutic options.

This symposium addressed new developments and controversies in diabetes and endocrinology. The practical management of hyperparathyroidism, thyroid nodules, hyperprolactinaemia and diabetes and thyroid disorders in pregnancy were all discussed. In addition to these traditional areas of endocrinology, there was a focus on the role of endocrinology in ‘non-endocrine’ specialties, namely critical care and cardiovascular disease.

An ever-increasing number of women with Type 2 diabetes mellitus (DM) are going through pregnancy and, with the current epidemic of obesity, more women are being diagnosed with gestational diabetes mellitus (GDM). Insulin has traditionally been the gold standard in diabetic pregnancy because of its efficacy and the fact that it does not cross the placenta. However, recent data from welldesigned trials and meta-analysis on the use of oral agents in  gestational diabetes may mark a significant shift in clinical practice.

Medical students are often faced with stressors such as high work demands, numerous assessments, placements and career choices. Using the results of a questionnaire we examined medical students’ attitudes and choices surrounding the impact of pregnancy and parenthood on studying medicine. Many questionnaire respondents (77.6%) believe that the decision to have a child is influenced by studying medicine; 23% have delayed becoming a parent and 7.5% have chosen not to have children.

This review is based in part on a presentation given by Dr Mackillop at the Neurology Symposium on 4 October 2012 at the Royal College of Physicians of Edinburgh.