DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20214332
Published: 2021-10-27

Seizure disorders in pregnancy: an insight beyond eclampsia and epilepsy

Arti Sharma, Vineeta Gupta, Prashant Sarda, Parul Singh, Nikita Gupta, Swati Kohli

Abstract


Background: Seizures in pregnancy contribute to poor maternal and perinatal outcome. Though eclampsia and epilepsy are common causes of seizures in pregnancy but there are several other conditions apart from eclampsia and epilepsy which give rise to convulsions. Objective of this study was to evaluate fetomaternal outcome in patients with seizure disorders as well as to analyze the other causes of seizures in pregnancy apart from eclampsia and epilepsy.

Methods: This prospective study was conducted in Shri. Guru Ram Rai institute of medical and health sciences, Dehradun, India over a period of 39 months from January 2017to March 2020, in all pregnant women with seizure disorders delivered in this hospital. In all cases demographic characteristics, causes of seizure with special attention on noneclamptic, non-epileptic conditions, maternal complications, mode of delivery and fetal outcome were noted.

Results: Total 97 cases with seizure disorders were included in the study. Mostly seizures were due to eclampsia and epilepsy in 91.75% cases. Among other causes neurocysticercosis, cerebral malformation, posterior reversible encephalopathy syndrome, brain tumor, and cerebral infarcts contributed to seizures in pregnancy in 8.25%cases. Maternal complications were premature rupture of membranes, gestational diabetes mellitus, hypothyroidism, anaemia, jaundice and abruption observed in37.11% cases. Live birth rate was 76.28%, prematurity was present in 27.83% cases and fetal growth restriction was seen in 7.21% neonates. There were 5 (5.15 %) neonatal deaths.

Conclusions: Seizure disorders in pregnancy are associated with significant increase in maternal and fetal risk. Maternal complications, cesarean section rate and neonatal complications are increased. Several other conditions apart from eclampsia, need to be considered in patients without epilepsy presenting with convulsions in pregnancy.

 


Keywords


Seizure disorders, Pregnancy, Eclampsia, Epilepsy, Neurocysticercosis

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References


American academy of neurology. Practice parameter management issue for women with epilepsy report of the quality standards. Neurol. 1998;51:944-8.

Sibai BM, Stella CL. Diagnosis and management of a typical preeclampsia-eclampsia. Am J Obstet Gynecol. 2009;200:e1-7.

Thomas SV. Management of epilepsy and pregnancy. J Postgrad Med. 2006;52:57-64.

Mustafa A, İsmail Ö, Yavuz D, Süber D. Atypical preeclampsia andeclampsia: report of four cases and review of the literature. J Turkish-German Gynecol Assoc. 2010;11:115-7.

Saleem S, McClure EM, Goudar SS, Patel A, Esamai F, Garces A, et al. A prospective study of maternal, fetal and neonatal deathsinlowandmiddleincome countries. Bull World Health Organ. 2014;92:605-12.

Nobis PN, Hajong A. Eclampsia in India through the decades. J Obstet Gynecol India. 2016;66:172-6.

Brewer J, Owens MY, Wallace K, Reeves AA, Morris R,Khan M, et al. Posterior reversible encephalopathy syndrome in 46of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208:468.e1-6

Wright WL. Neurologic complications in critically ill pregnantpatients. Handb Clin Neurol. 2017;141:657-74.

Nathan J. Women with epilepsy. J Obstet Gynecol India. 2004;54:543-53.

More MJ. Epilepsy and pregnancy: minimizing the risks. Contemp Obstet Gynecol. 2004;49:51-70.

Meador KJ, Baker GA, Finnell RH. In utero antiepileptic drug exposure: fetal death and malformations. Neurol. 2006;67:407-12

Rebecca FD, Sher MN, Pooja D. Neurocysticercosis in pregnancy: maternal and fetal outcomes. Oxford Med Case Rep. 2016;7:138-40.

Garcia H, Nash T, Del Brutto O. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol. 2014;3:1202-15.

Anoosha KR, Poonam S, Gauri G, Anubhuti R. Pregnancy with Meningioma: Report of Two Rare Cases. J Case Rep. 2017;7(3):322-4.

Kanaan I, Jallu A, Kanaan H. Management strategy for meningioma in pregnancy: A clinical study. Skull Base. 2003;13:197-203.

Yust-Katz S, John FG, Diane L, Jimin W, Ying Y, Mark DA. Pregnancy and glial brain tumors. Neuro-Oncol. 2014;16(9):1289-94.

Roelvink NC, Kamphorst W, van Alphen HA. Pregnancy-related primary brain and spinal tumors. Arch Neurol. 1987;44(2):209-15.

Claus EB, Black PM. Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program,1973-2001. Cancer. 2006;106(6):1358-63.

Vandenbossche G, Maquet J, Vroonen P, Lambert G, Nisolle M, Kridelka F, et al. A reversible posterior leuco encephalopathy syndrome including blindness caused by preeclampsia. Facts Views Vis Ob Gyn. 2016;8:173‑7.

Van Alebeek ME, de Heus R, Tuladhar AM, de Leeuw FE. Pregnancy and ischemic stroke: a practical guide to management. Curr Opin Neurol. 2018;31(1): 44-51.

Finnerty JJ, Chisholm CA, Chapple H, Login IS, Pinkerton JV. Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance. Am J Obstet Gynecol. 1999; 181(2):296-303.

Goel P, Devi L, Saha PK, Takkar N, Huria A, Dua D. Maternal and perinatal outcome in pregnancy with epilepsy. Internet J Gynecol Obstet. 2006;5:45-9.

Raji C, Sekar D. Prospective study of fetomaternal outcome in epilepsy in pregnancy in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6(11):5055-9.