Status epilepticus associated with pregnancy: A cohort study |
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| Institution: | 1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;2. Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;3. Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;4. Department of Pathology and Laboratory Medicine, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan;5. Center for Translational Research in Biomedical Sciences, Kaohsiung, Taiwan;6. Department of Biological Science, National Sun Yet-Sen University, Kaohsiung, Taiwan;7. Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;8. Department of Nursing, Meiho University, Pingtung, Taiwan;1. Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland;2. Department of Child Neurology, University of Turku and Turku University Hospital, Turku, Finland;3. Doctoral Programme of Clinical Investigation, University of Turku, Turku, Finland;4. Epilepsy Research Group, Berlin, Germany;5. Research Department, The Social Insurance Institution of Finland (KELA), Turku, Finland;1. Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel;2. Pharmacology Branch, Research Division, US Army Medical Research Institute of Chemical Defense (MRICD), Aberdeen Proving Ground, MD, USA;1. Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom;2. Scottish Epilepsy Centre, Glasgow, United Kingdom;3. Department of General Practice, University College Cork, Cork, Ireland;4. Neurology Department, Luton & Dunstable Hospitals NHS Trust, Luton, United Kingdom;5. Department of Medical Genetics, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom;6. Royal Manchester Children''s Hospital, Central Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom;7. Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom;8. Women''s Centre. Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;9. Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom;10. Department of Neurology, Beaumont Hospital, Dublin, Ireland;11. Department of Neurology, Beaumont Hospital, and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland |
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| Abstract: | BackgroundStatus epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. Status epilepticus in pregnancy poses a tremendous threat to both mother and fetus, making a correct diagnosis and treatment a challenging task for clinicians. The prevalence, underlying etiology, and outcomes of pregnancy-related SE remain largely unknown.MethodsWe retrospectively studied all SE episodes (n = 366) in patients admitted to our neurological ICU over a period of 8.5 years. The patients who developed SE during pregnancy and within 6 months after delivery were considered to have pregnancy-related SE. Patients with eclampsia were not included as they were usually cared for in our obstetric unit.ResultsSeven patients with pregnancy-related SE were identified (2.1% of all cases of SE), with the majority (85%) occurring de novo except for one patient who had a previous history of epilepsy-related SE due to withdrawal of antiepileptic medication. In terms of etiology, limbic encephalitis and cerebral venous sinus thrombosis were the two main etiologies of de novo SE associated with pregnancy. The overall mortality rate was 28.5% at discharge, and poor outcomes were especially noted in the patients with limbic encephalitis compared to other etiologies.ConclusionsPregnancy-associated SE is rare and predominantly occurs in patients without a history of epilepsy. An autoimmune etiology should be considered in pregnant patients with de novo SE, which was associated with poor outcomes. Thorough investigations and prompt treatment according to the etiology may be required to improve the final outcomes of both mother and fetus. |
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