Abstracts

Rationale: Autoimmune conditions flare in the post-partum period, but there has not been an association reported with new-onset autoimmune epilepsy. We report a case of new-onset refractory status epilepticus in the post-partum period with an associated autoimmune disorder. Methods: We performed a retrospective case review from one hospital admission. Results: A 30-year-old woman without known past medical history was admitted for induction of labor due to intrauterine growth restriction. Twelve hours after delivery she was lethargic, disoriented and incoherent with unremarkable vital signs. She then had a clinical seizure consisting of lip smacking and right arm automatism with evolution to tonic-clonic movement in the right arm. While she did not have preeclampsia prior to developing seizures, once she started seizing she had elevated diastolic blood pressures and intermittent proteinuria suggestive of eclampsia. She had no clinical improvement with IV magnesium (2 gm) or fosphenytoin. On post-partum day (PPD) 2, she progressed to develop status epilepticus with increased seizure frequency and bilateral independent seizure onset with associated clinical deterioration. She became obtunded with hypercapnic respiratory failure and absent deep tendon reflexes requiring emergent intubation. Her seizures remained refractory to treatment for 28 days. During her course, multiple therapies were implemented including anti-seizure medications, empiric antibiotic therapy, high-dose IV steroids, and plasmapheresis. A search for the etiology of her new-onset seizures was positive for an elevated ANA and positive Sjogren’s antibodies. The initial MRI Brain showed no evidence of a PRES-like syndrome. A subsequent MRI several days later showed T2/FLAIR hyperintensities involving bilateral basal ganglia and hippocampi, which were thought to be consistent with either autoimmune encephalitis or ongoing seizures. In addition, there were punctate cystic foci in the parotid glands, which can be found with Sjogren’s disease. Conclusions: New-onset seizures in the immediate postpartum period are most often due to eclampsia. In this case, however, the seizures did not resolve with magnesium and multiple anti-seizure medications, suggesting an alternate seizure etiology. While rare, Sjogren’s disease has been associated with autoimmune epilepsy. As pregnancies come to an end, the body goes into a pro-inflammatory state that promotes labor and delivery. These immunologic changes can lead to increased autoimmune disease activity. While autoimmune epilepsy flares have not previously been described in the post-partum period, the current case suggests that it could be a high-risk period for the onset of autoimmune epilepsy. Funding: No funding was provided in support of this abstract.