Maternal and Fetal Outcomes of Status Epilepticus During Pregnancy in Women with Drug Resistant Epilepsy
Abstract number :
V.057
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2021
Submission ID :
1825977
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Jeetendra sah, MD - University of Pittsburgh Medical Center; Hesham Ghonim, MD – Fellow, Neurology, University of Pittsburgh Medical Center; Vijayalakshmi Rajasekaran, MD – Attending Physician, Neurology, University of PIttsburgh Medical Center; Anto Bagic, MD, PhD, FAES, FACNS – Attending Physician, Neurology, University of Pittsburgh Medical Center; Alexandra Urban, MD – Attending Physician, Neurology, University of Pittsburgh Medical Center
Rationale: About 40% of women with epilepsy (WWE) are in the reproductive age group. Status epilepticus (SE) during pregnancy can negatively affect women’s health and fetal outcome. The prevalence of SE in pregnant women with drug-resistant epilepsy (WDRE) is 8.5%. There is limited literature on fetal and maternal outcomes of WDRE developing SE during pregnancy.
Methods: The study received approval from the Institutional review board. We retrospectively identified WDRE who presented with SE, between 2012 and 2020. Medical records of mother and infants were reviewed to identify management of SE during pregnancy, maternal and fetal outcomes and complications during pregnancy and delivery.
Results: We identified six pregnant WDRE with mean age of 25.66 years (range 17-31) treated for SE. Two women had generalized epilepsy (P1, P2) while four (P3-6) had focal epilepsy. Baseline seizure frequency was daily (P5, P6) or monthly (P1-4). The anti-seizure medication (ASM) regimen prior to SE was: polytherapy with 2 ASMs (P2, P4) and polytherapy with > 3 ASMs (P1, P3, P5, P6). In our cohort, the SE presentation was not due to noncompliance. P1 presented with generalized tonic-clonic seizures, P2 with absence status, two (P3, P4) with epilepsia partialis continua, P5 in focal status and P6 with focal to bilateral tonic-clonic seizures. Cases presented during all stages of pregnancy (P2 & P6 in the first, P1 in second and P3-5 in the third trimester). During SE the first line agent used was lorazepam (P2-4, P6) or midazolam (P1, P5). All cases received levetiracetam load along with increase dosages of home ASMs, with 2 patients (P5-6) requiring add on ASMs (valproic acid (P5); lacosamide (P5 & 6), diazepam and felbamate (P6)) for seizure suppression. Three patients (P1, P5-6) required intubation and anesthetic use (propofol and midazolam), with additional pentobarbital in one case (P6) who also underwent a partial right frontal resection. One patient (P3) received magnesium infusion in addition to ASMs. All WDRE survived, with 4 discharged to home, one discharged to rehabilitation and one to long term facility. There was no recurrence of SE during pregnancy but 2 patients had recurrent SE outside of pregnancy. There were 5 babies delivered out of which 3 were term (P1&P4 via cesarean section and P2 vaginal delivery) and 2 were premature induction of labor with vaginal delivery at gestational age 33 (P3) and 35 (P5) weeks due to maternal SE. There was one (P6) intrauterine fetal death. Two premature newborns required initial resuscitation due to respiratory distress, out of which one (P3) was small for gestational age (SGA) and delivery was complicated by eclampsia. No major malformations were present in newborns.
Conclusions: Although SE is a major issue in pregnant WDRE, literature is lacking on maternal and fetal outcomes. Our small cohort showed no maternal mortality and satisfactory fetal outcome in 5 of 6 pregnancies. In contrast to the literature, the SE presentation was not due to noncompliance. Prematurity, respiratory distress and SGA were the most common neonatal complications.
Funding: Please list any funding that was received in support of this abstract.: Nothing to disclose.
Clinical Epilepsy