Abstracts

We report a 43 yr old woman with complex partial seizures (CPS) whose seizures during pregnancy were associated with fetal heart rate deceleration and bradycardia. Partial seizures may affect fetal welfare.
Case Report
A 43 yr old woman with CPS secondary to 3 radiographically stable cavernous hemangiomas became inadvertently pregnant. During an admission in the seventh month she was documented to have a CPS while being on a fetal monitor (figure 1). The seizure, witnessed by staff physicians consisted of right facial twitching followed by right arm and leg twitching, without generalization. Maternal tachycardia up to 150 b.p.m. was documented. She became transiently hypoxic during the tachycardia. The seizure lasted one minute, followed by a quick recovery. The fetal heart rate decelerated acutely during the seizure for 2.5 minutes, from a baseline rate of 150-160 to a low of 70 b.p.m. The rest of the pregnancy was uneventful ending in a normal delivery.
The detrimental effect of trauma related to seizures with prolonged generalized tonic-clonic seizures (GTCS) is well described [1]. GTCS have been noted to be associated with fetal hypoxia and occasional fetal deaths [2,3,5], although fetal bradycardia may be absent during even prolonged maternal GTCS without maternal hypoxia [4]. It is generally assumed in clinical practice that partial simple and complex seizures probably do not significantly affect the fetus [6]. One case has previously been reported with fetal cardiac deceleration during a CPS and increased uterine contractility.[7]. Our patient experienced a CPS with limited motor manifestations, without an increase in uterine contractions to explain the fetal bradycardia. The presence of tachycardia early in the seizure suggests autonomic nervous system involvement by the seizure, e.g. of the insula or the cingulate gyrus [8]. It is possible that seizure-triggered transient maternal dysautonomia resulted in secondary fetal bradycardia. It is conceivable that significant, recurrent or prolonged fetal deceleration associated with clinically benign-appearing partial seizures might affect fetal welfare and development. A prospective study of the effect of partial seizures on fetal heart rate is warranted.
References-
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