Abstracts

RATIONALE: Eclampsia is defined as seizures or coma in setting of pregnancy induced hypertension (PIH). We studied seizure characteristics in women with eclampsia.
METHODS: The patients were studied prospectively and informed consents were obtained. The protocol is approved by local IRB. A neurologist performed a history and physical including neurological exam. All women fulfilled criteria for diagnosis of eclampsia. The seizures were classified according to the criteria for seizure classification published by ILAE. Six months or later follow-up information was obtained by phone or personal interview when possible.
RESULTS: Total of 40 women was included in study. Average gestational age on admission was 34.9 weeks and at delivery was 35.3 weeks. Ethnic background was as follows: African American 35 (88%), Hispanic 1 (2%) and Caucasian 4 (10%). Half of the women were primiparas. Twenty percent of the women reported a family member with history of seizures. Seizures were presenting complaint in 17 (45%), headache in 7 (18%), and various obstetrical reasons including PIH in 16 (42%). One patient developed coma in setting of PIH and cerebral edema, but no seizures and was excluded from further calculations. None of the women died. Seizures were generalized tonic-clonic in 33 women and partial with or without secondarily generalization in 8 (2 had both partial and generalized seizures). Total of 22 women had a single seizure, 10 had 2 seizures, 2 had 3 seizures and 3 had 4 or more seizures. One woman developed status epilepticus. Seizures were prepartum in 14 (36%), intrapartum in 3 (8%) and postpartum in 22(56%) women. In women with prepartum seizures, baby was delivered within first day after the seizure. In 22 women with postpartum eclampsia, seizure occurred on the first postpartum day in 8 women, 2 days postpartum in 5, 3-6 days postpartum in 4 and greater than 6 days postpartum in 5 women. Headache was part of the syndrome in 33 women (85%). It preceded seizures in majority by more than a day. In 15 women it was present for a day, in 7 for 2 days and in 8 for 3 or more days prior to occurrence of seizure. Six months follow-up information was available in 13 (33%) women. No permanent neurological deficits were present, but 2 of them had developed recurrent seizures and were taking an AED. Four women had developed new recurrent headache.
CONCLUSIONS: Seizures in eclampsia are single generalized tonic clonic in majority of the women. However, partial seizures and multiple seizures can occur. They are usually preceded by headache for a day or more. Prognosis for mothers is benign, but few women may develop epilepsy or recurrent headaches.