Seizures In Pregnancy Research Articles

Convulsions in pregnancy-not always eclampsia role of neuro-imaging in diagnostic dilemma

Background: Convulsions in pregnancy is always considered and treated as Eclampsia unless otherwise proved. Eclampsia is associated with increased risk of maternal death varying from 1.8 % to 14 % in developed countries. Despite availability of Intensive care units and improved antenatal care, some women still die from Eclampsia. Cerebral complications are the major cause of death in eclampsia patients. Hypercoagulopathy of pregnancy is a high risk factor for these patients in respect to development of cerebro vascular thrombosis and ischaemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various Central Nervous System pathological conditions amenable to the medical treatment.Objective: To study the neuro pathophysiology behind a seizure in pregnancy and to reduce the morbidity associated with it. To study the role of neuro-imaging in patients with convulsions in pregnancy not responding to treatment with magnesium sulphate (MgSo4).Methods: It was a prospective study design which included 50 antenatal mothers. All patients were admitted in the eclampsia room with history of convulsions and all of them were put on MgSo4 therapy and Antihyperertensives. The patients who were refractory to the treatment such as having recurrent convulsions despite therapy with MgSo4 were selected for neuro- imaging with Computed Tomography scan. Neuro-imaging was done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the trans-axial plane. Abdomen shielding was done with lead shield to prevent radiation hazard in the antenatal period.The results were documented and analysed using appropriate statistical method.Results: The CT scanning report revealed: Cerebral oedema (30/50), Encephalopathy (10/50), Intra Cranial Haemorrhage (02/50) Cerebral infarction (01/50), Cortical venous sinus thrombosis (01/50), Tuberculomas (01/50), Neurocysticercosis (01/50) and Hydrocephalus (01/50). Three patients out of 50 had normal CT scan report. Conclusion: Patients with convulsions in pregnancy who were refractory to the treatment with MgSo4 and Antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuro imaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patients conditions and have reduced morbidity and mortality. Health Renaissance 2015;13 (3): 144-151

New-Onset Seizures in Pregnancy and Puerperium

Seizures in pregnant women cause several maternal and fetal consequences. Eclampsia is usually diagnosed to be the etiology. However, seizures during pregnancy or puerperium could be caused by pre-existing epilepsy, the initial presentation of a non-pregnancy-related disorder or the new-onset pregnancy-related disorder. Therefore, thorough diagnostic evaluation is essential. Although the pathogenesis of new-onset pregnancy-related neurological disorders remains unknown, physiological changes during pregnancy and puerperium are believed to have a major role. Advanced neuroimaging of the brain and cerebral vessels can help in differentiating the specific causes of seizures in these patients.

Community health worker knowledge and management of pre-eclampsia in rural Karnataka State, India.

BackgroundIn India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess. However, there is limited research regarding their ability to manage pregnancy complications. This study aims to describe the current state of knowledge regarding pre-eclampsia and eclampsia among community health care workers (auxiliary nurse midwives, accredited social health activists, staff nurses) in northern Karnataka, India. Furthermore, this study describes the treatment approaches used by various cadres of community health workers for these conditions. The findings of this study can help plan focussed training sessions to build upon their strengths and to address the identified gaps.MethodsData were collected as part of a larger study aimed at assessing the feasibility of community-based treatment for pre-eclampsia. Eight focus group discussions were conducted in 2012–2013 in northern Karnataka State: four with staff nurses and auxiliary nurse midwives and four with accredited social health activists. In addition, twelve auxiliary nurse midwives and staff nurses completed questionnaires to explore their competence and self-efficacy in managing pre-eclampsia. Qualitative data were audio-recorded, transcribed verbatim and translated for thematic analysis using NVivo 10.ResultsCommunity health workers described their understanding of the origins of hypertension and seizures in pregnancy. Psychological explanations of hypertension were most commonly reported: stress, tension, and fear. The most common explanation for eclampsia was not receiving a tetanus vaccination. Despite some common misperceptions regarding aetiology, these community health workers demonstrated a good grasp of the potential consequences of hypertension in pregnancy. According to auxiliary nurse midwives and staff nurses, if hypertension was detected they encouraged rest, decreased salt intake, iron supplementation and tetanus vaccination. In addition, some staff nurses administered antihypertensives, MgSO4, or other anticonvulsants. All auxiliary nurse midwives had some awareness of MgSO4, but none had administered it themselves.ConclusionsThis study showed that knowledge regarding the aetiology of pre-eclampsia was limited. Nevertheless, their basic knowledge and skills could be strengthened to more effectively manage the hypertensive disorders of pregnancy in their communities.Trial registration NCT01911494 Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0219-8) contains supplementary material, which is available to authorized users.

Community perceptions of pre-eclampsia and eclampsia in southern Mozambique.

BackgroundSub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique.MethodsThis qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken.ResultsThe conditions of “pre-eclampsia” and “eclampsia” were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman’s body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet.ConclusionLocal beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications.Trial RegistrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0135-y) contains supplementary material, which is available to authorized users.

Community perceptions of pre-eclampsia and eclampsia in Ogun State, Nigeria: a qualitative study.

BackgroundPre-eclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in sub-Saharan Africa. When undetected or poorly managed, it may progress to eclampsia which further worsens the prognosis. While most studies examining pre-eclampsia have used a bio-medical model, this study recognizes the role of the socio-cultural environment, in order to understand perceptions of pre-eclampsia within the community.MethodsThe study was conducted in Ogun State, Nigeria in 2011–2012. Data were obtained through twenty-eight focus group discussions; seven with pregnant women (N = 80), eight with new mothers (N = 95), three with male decision-makers (N = 35), six with community leaders (N = 68), and three with traditional birth attendants (N = 36). Interviews were also conducted with the heads of the local traditional birth attendants (N = 4) and with community leaders (N = 5). Data were transcribed verbatim and analysed in NVivo 10 software.ResultsThere was no terminology reportedly used for pre-eclampsia in the native language - Yoruba; however, hypertension has several terms independent of pregnancy status. Generally, ‘gìrì âlábôyún’ describes seizures specific to pregnancy. The cause of hypertension in pregnancy was thought to be due to depressive thoughts as a result of marital conflict and financial worries, while seizures in pregnancy were perceived to result from prolonged exposure to cold. There seemed to be no traditional treatment for hypertension. However for seizures the use of herbs, concoctions, incisions, and topical application of black soap were widespread.ConclusionThis study illustrates that knowledge of pre-eclampsia and eclampsia are limited amongst communities of Ogun State, Nigeria. Findings reveal that pre-eclampsia was perceived as a stress-induced condition, while eclampsia was perceived as a product of prolonged exposure to cold. Thus, heat-related local medicines and herbal concoctions were the treatment options. Perceptions anchored on cultural values and lack of adequate and focused public health awareness is a major constraint to knowledge of the aetiology and treatment of the conditions. A holistic approach is recommended for sensitization at the community level and the need to change the community perceptions of pre-eclampsia remains a challenge.Trial RegistrationNCT01911494.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0134-z) contains supplementary material, which is available to authorized users.

Community perceptions of pre-eclampsia in rural Karnataka State, India: a qualitative study.

BackgroundMaternal deaths have been attributed in large part to delays in recognition of illness, timely transport to facility, and timely treatment once there. As community perceptions of pregnancy and their complications are critical to averting maternal morbidity and mortality, this study sought to contribute to the literature and explore community-based understandings of pre-eclampsia and eclampsia.MethodsThe study was conducted in rural Karnataka State, India, in 2012–2013. Fourteen focus groups were held with the following community stakeholders: three with community leaders (n = 27), two with male decision-makers (n = 19), three with female decision-makers (n = 41), and six with reproductive age women (n = 132). Focus groups were facilitated by local researchers with clinical and research expertise. Discussions were audio-recorded, transcribed verbatim and translated to English for thematic analysis using NVivo 10.ResultsTerminology exists in the local language (Kannada) to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. Community participants perceived stress, tension and poor diet to be precipitants of hypertension in pregnancy. Seizures in pregnancy were thought to be brought on by anaemia, poor medical adherence, lack of tetanus toxoid immunization, and exposure in pregnancy to fire or water. Sweating, fatigue, dizziness-unsteadiness, swelling, and irritability were perceived to be signs of hypertension, which was recognized to have the potential to lead to eclampsia or death. Home remedies, such as providing the smell of onion, placing an iron object in the hands, or squeezing the fingers and toes, were all used regularly to treat seizures prior to accessing facility-based care although transport is not delayed.ConclusionsIt is evident that ‘pre-eclampsia’ and ‘eclampsia’ are not well-known; instead hypertension and seizures are perceived as conditions that may occur during or outside pregnancy. Improving community knowledge about, and modifying attitudes towards, hypertension in pregnancy and its complications (including eclampsia) has the potential to address community-based delays in disease recognition and delays in treatment that contribute to maternal and perinatal morbidity and mortality. Advocacy and educational initiatives should be designed to target knowledge gaps and potentially harmful practices, and respond to cultural understandings of disease.Trial registrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0137-9) contains supplementary material, which is available to authorized users.

Having Catamenial Epilepsy Equals Fewer Seizures in Pregnancy.

Having Catamenial Epilepsy Equals Fewer Seizures in Pregnancy.

Short- and long-term neurological and psychiatric sequelae of developmental exposure to antiepileptic and anesthetic drugs.

Phenobarbital has been in clinical use for over a century; phenytoin for more than three-quarters of a century, and volatile anesthetics, such as isoflurane and halothane for more than half a century. Despite the long history of use of these compounds for the treatment of epilepsy, and for anesthesia, their effects on brain development are still relatively poorly understood. For this reason, the use of neuroactive drugs during gestation and infancy remains one of the thorniest issues in clinical neurology and neonatology. I had the privilege of co-editing this research topic with my mentor, colleague, and friend, Dr. Karen Gale. Dr. Gale passed away in August of 2014. She and I saw this research topic as an opportunity to highlight the state of the field, and in particular, underscore important future research directions. Together, these articles do exactly that. In this research topic, the current state of the field is reviewed from pre-clinical and clinical perspectives by Turski and Ikonomidou (1) and Gedzelman and Meador (2). These reviews highlight converging results from animal and human studies that underscore the profound impact of these drugs can have on the developing brain. Complementing these reviews, Rochelle Caplan’s translational review focuses on the role of antiepileptic drugs in psychopathology seen in pediatric epilepsy (3). From a translational perspective, the review by Khanna and colleagues (4), and the opinion piece by Pressler and Auvin (5) highlight the importance of neuronal chloride homeostasis as a key regulator of neuronal activity during brain development and as a critical mediator of the efficacy of the first-line therapies for neonatal seizures (i.e., phenobarbital). With respect to anesthesia, the review from Jevtovic-Todorovic and colleagues (6) approaches the problem of anesthesia-induced damage to the developing brain from a highly mechanistic perspective. In particular, they highlight the role of sub cellular organelles, such as mitochondia, in the pathophysiology of neonatal anesthesia exposure. Furthermore, the review by Cheng Wang outlines research approaches and models that have been employed in pre-clinical pediatric neurotoxicology experiments (7). Finally, the research article by Murphy and Baxter highlights sex-dependent effects of neonatal anesthesia exposure on long-term cognitive outcomes (8). In the decade and a half since the first characterization of apoptotic neurodegeneration in the developing rat brain after exposure to these drugs (9–11), this field has made considerable advances in understanding mechanisms of toxicity and characterizing the types of lasting injury that occur after early drug exposure. Indeed, the importance of this research was highlighted in the 2014 NINDS Benchmarks for Epilepsy Research, which lists as a goal, “[To] identify the impact of pharmacological treatment of the epilepsies on fetal and neonatal development. Develop strategies to control seizures in pregnancy without causing harm to either the mother or child” (12). There are, however, many questions that remain to be addressed. To what degree do the mechanisms of developmental neurotoxicity overlap and differ between classes of drugs (e.g., anesthesia vs. antiepileptic drugs). How can pre-clinical research influence clinical practice with respect to these drugs? What therapeutic strategies and adjunct treatments can be used to minimize/avoid developmental neurotoxicity? How does sex modulate risk for developmental neurotoxicity? What features and types of toxicity will be revealed by studies in non-human primate models? It is my sincere hope that 10 years from now, we will have made considerable progress in addressing these issues.

The efficacy of the newer antiepileptic drugs in controlling seizures in pregnancy.

To assess the effectiveness of the newer antiepileptic drugs (AEDs)-in particular lamotrigine, topiramate, and levetiracetam-in controlling epileptic seizures in pregnant women. Analysis of data in the Australian Register of Antiepileptic Drugs in Pregnancy concerning seizure control in 1,534 pregnancies in women with AED-treated epilepsies. In AED monotherapy (1,111 pregnancies), use of levetiracetam in pregnancies in the Australian Register was associated with levels of seizure control similar to those that applied for the major older AEDs carbamazepine and valproate, but with levels of seizure control superior to those associated with use of lamotrigine and topiramate. Levetiracetam shows promise as a satisfactory drug for controlling seizures in pregnancy.

Cerebral Venous Sinus Thrombosis Presenting with Seizure in Pregnancy

Giris: Serebral sinus ven trombozu nadir bir durumdur. En sik semptom ve bulgulari; sekonder jeneralizasyon gosteren ve gostermeyen fokal nobetler, tek veya cift tarafli gucsuzluk ve papilodemdir. Bu olguda, nobet gecirme sonrasinda basvuran gebe bir kadinda saptanan sol transvers ve sigmoid sinus trombozunu sunuyoruz. Olgu Sunumu: Gebeliginin 33. haftasinda olan, 31 yasinda kadin hasta acil servise nobet sikayeti ile basvurdu. Beyin manyetik rezonans goruntulemesinde; serebellar hemisferlerde kortikal – subkortikal enfarkt ile manyetik rezonans venografide sol transvers sinus ve sigmoid sinus trombozu saptandi. Hasta fenitoin ve enoksaparinle tedavi edildi; fetus ise acil sezaryen girisimi sonrasinda dogurtuldu. Sonuc: Nobet sonrasinda basvuran gebe kadin hastalarda, serebral sinus ven trombozu da ayirici tanida dusunulmelidir.

PMM.47 When a fit does not fit the clinical diagnosis: seizures in pregnancy with epilepsy and pre-eclampsia……. diagnosis of Posterior Reversible Encepholopathy Syndrome (PRES)

A 39-year-old Para 1 with known idiopathic generalised epilepsy presented at term with a short history of vomiting and visual disturbance. She was subsequently identified as having borderline hypertension with...

Obstetric and Intrapartum Emergencies: A Practical Guide to Management Edited by EdwinChandraharan, SabaratnamArulkumaran. New York: Cambridge University Press, 2012; 282 pp; $69.95 (softcover).

Obstetric and Intrapartum Emergencies: A Practical Guide to Management is a soft-covered book outlining the various emergencies that providers may encounter when working in an environment of pregnant patients. This book review came at a perfect time. At one of the places I currently work, there was a recent change in staffing where the emergency physicians are now responsible for care of the pregnant patients, regardless of their weeks of gestation. So after practicing for over 15 years without managing pregnant patients over 20 weeks, this dog had to relearn some old tricks and learn some new ones as well. I can tell you it can be quite frightening. So when I reviewed this book, I was looking at whether this guide would be able to assist me in both types of hospital settings. Would it be comprehensive enough in the limited-resource facility? The resources used to write this book came from contributors practicing in well-resourced and less-resourced centers in the United Kingdom and Sri Lanka. The book is divided into 40 brief, well-focused chapters, each being around six pages long. The topics are divided into nine sections, such as general principles, intra- and postpartum emergencies, medical and surgical emergencies in pregnant patients, imminent deliveries, and simulation training. Each chapter is divided into sections that include key actions, key pearls, key pitfalls, and what is crucial to do when in a “low-resource setting.” Some of the chapters have stimulation cases that walk one through step-by-step instructions on how to approach certain patient problems. The key actions review the important aspects of the case, as well as the simplest thing you might overlook, for example, not just calling an obstetrician for an imminent delivery, but also informing her or him in the case of a cord prolapse, so she or he can get the operating room ready. One of the positive aspects of this book is the inclusion of algorithms for the management of specific obstetric emergencies, such as preeclampsia/eclampsia, obstetric hemorrhage, septic shock, and seizure in pregnancy. These algorithms are clear and concise and can easily be referenced. Another positive aspect of this book is the common toxicologic ingestion table. It is a quick reference table listing potential common drugs ingested by the pregnant patient, along with the clinical effects and the actions that need to be taken. What kind of provider would find this book helpful? This book will be helpful to providers who infrequently encounter the second- and third-trimester pregnant patient, whether it be the emergency physician, family practitioner, midwife, or nurse. It is a concise overview of the complications one might encounter treating the pregnant patient. It is a starting point for treating and stabilizing the patient, until the appropriate provider—the obstetrician—can take over. However, if you are looking for a detailed protocol of breech delivery or a shoulder dystocia, this is not the book for you.

The effect of socioeconomic status on treatment and pregnancy outcomes in women with epilepsy in Scotland

Compared to the background population, people with epilepsy tend to have lower rates of education and employment, lower rates of marriage and childbearing, and lower overall socioeconomic status (SES). Disparities in epilepsy care based on sociodemographic factors have been observed in the literature, but it is not known whether any such disparities exist in the UK.The UK Epilepsy and Pregnancy Register is a prospective, observational, registration and follow-up study that was set up to determine the relative safety of all AEDs taken in pregnancy. Here, we report outcomes of registered pregnancies to women with epilepsy living in Scotland from December 1996 to June 2012, based on the degree of socioeconomic deprivation of their postcode area. The Scottish Index of Multiple Deprivation (SIMD) quintile scores from 2006 were used to determine degree of socioeconomic deprivation, and group 1 (most deprived) and group 5 (least deprived) were compared.There were 1526 pregnancies with complete outcome data to women living in Scotland. Of these, 1453 (95.1%) resulted in a live birth and 68 (4.7%) had a major congenital malformation (MCM). Postcodes could not be reliably identified or verified for an additional three women, who have been excluded from SIMD group analysis. Of all women included in this study, 32.4% were in group 1 and 13.2% in group 5. No difference in MCM rate was observed between the two groups (4.4% in group 1 compared to 4.7% in group 5, p=0.84). Women in group 5 were more likely to take preconceptual folic acid (56.8% compared to 14.0%, relative risk: 4.1; 95% CI: 3.1–5.2) and less likely to have generalized tonic–clonic seizures in pregnancy (13.0% compared to 29.2%, relative risk: 0.4; 95% CI: 0.3–0.7) than those in group 1. Women in group 5 were more likely to be on monotherapy regimens (80.2% compared to 65.9%, relative risk: 1.2; 95% CI: 1.1–1.3), less likely to be on valproate (19.5% compared to 28.0%, p=0.05), and more likely to be on lower doses of the drug (825.9mg/day compared to 1012.0mg/day, p=0.05) compared to those in group 1.Although no change in MCM rate was seen based on SES, differences in treatment between socioeconomic groups do exist, particularly for preconceptual folic acid consumption, AED regimen, and seizure frequency. Greater emphasis on the importance of preconceptual counseling, both to discuss AED choice and folic acid intake, would be of benefit, particularly to those living in areas of high socioeconomic deprivation, to improve equity of healthcare delivery for women with epilepsy in Scotland.

A deceptive case of seizure in pregnancy

A deceptive case of seizure in pregnancy

Tubercular meningitis: a rare cause of convulsions in pregnancy

IntroductionEclampsia is a common cause of new onset self-terminating tonic-clonic seizures in term pregnancy. Other causes of seizures such as epilepsy and central nervous system infection, haemorrhage, infarction, mass or...

Management of glioblastoma multiforme in pregnancy

Glioblastoma multiforme presenting during pregnancy presents unique challenges to the clinician. In planning treatment, potential benefits to the mother must be balanced against the risks to the fetus. In addition, evidence relating to timing of surgery and the use of radiotherapy and chemotherapy in pregnancy is limited. Management of peritumoral edema and seizures in pregnancy is also complicated by the potential for drug-related teratogenic effects and adverse neonatal outcomes on the fetus. The general anesthetic used for surgery must factor obstetric and neurosurgical considerations. In this review article, the authors seek to examine the role, safety, and timing of therapies for glioblastoma in the context of pregnancy. This covers the use of radiotherapy and chemotherapy, timing of surgery, postoperative care, anesthetic considerations, and use of anticonvulsant medications and steroids. The authors hope that this will provide a framework for clinicians treating pregnant patients with glioblastomas.

Neurocysticercosis as an important differential of seizures in pregnancy: two case reports

IntroductionSeizures in pregnancy usually result from eclampsia, epilepsy or central nervous system disorders. Neurocysticercosis is a rare, but an important, cause of first-time convulsions in pregnancy.Case presentationsWe report the cases of two Indian women, aged 20 and 24 years old respectively, with neurocysticercosis presenting in the second trimester of pregnancy with convulsions. Both had marginally raised blood pressure with 1+ urine albumin and neither had a past history of convulsions. The neurocysticercosis was diagnosed on magnetic resonance imaging of the head, which showed spherical ring-enhancing lesions in the brain. In one woman, pregnancy was terminated due to spina bifida in the fetus and she was discharged on albendazole and phenytoin. The second woman was put on carbamazepine: she had an emergency Cesarean section at term for fetal distress and delivered a healthy baby. Her postnatal period was uneventful.ConclusionNeurocysticercosis should be considered in pregnant women presenting with seizures which cannot be explained by eclampsia, especially in early pregnancy.

Effect of prenatal pentylenetetrazol-induced kindling on learning and memory of male offspring

Current data concerning the effects of maternal seizure during pregnancy on newborns are limited. This study was carried out to investigate the effect of prenatal pentylenetetrazol (PTZ)-induced kindling on learning and memory of offspring. Female Wistar rats were kindled with i.p. injections of 25 mg/kg of PTZ on day 13 of their pregnancy. The spatial performance and passive avoidance learning of pups were tested at 7 weeks and 12 weeks of age using Morris water maze (MWM) task and shuttle-box apparatus, respectively. We found, for the first time, that prenatal exposure to maternal seizure induced by PTZ leads to a significant impairment of learning and memory. In addition, the number of live birth was significantly lower in kindled rats compared to control. In MWM studies, the young offspring of kindled rats had poor spatial learning ability. The frequent tonic-clonic seizures in pregnancy was also associated with a poor memory as evidenced by decrease in distance swam in the target quadrant by the offspring of the kindled mother in the adulthood. Data obtained from shuttle-box studies showed that retention latencies of pups born to kindled dams were significantly reduced compared to those born to control dams. The hippocampus, amygdala and frontal cortex are very important for memory consolidation and our data suggest that subsequent developmental events are not sufficient to overcome the adverse effects of prenatal exposure to maternal seizures to these regions of the brain. These observations may have clinical implications for cognitive and memory dysfunction associated with epilepsy during pregnancy.

Proteinuria in status epilepticus or eclampsia; a diagnostic dilemma

A 36-year-old primigravida with a history of temporal lobe epilepsy presented at 25 weeks of pregnancy with generalized tonic clonic seizures. The clinical picture was confused with eclampsia because of rising blood pressure and proteinuria. Clinical investigations, which included a lumbar puncture, were carried out to rule out an infective cause for the seizures. A computed tomography of the brain was performed for evidence of intracranial hemorrhage. The patient was intubated and ventilated in the intensive care unit. The labile blood pressure settled in 2 days, and the transient heavy proteinuria also resolved after 3 days. Eclampsia would have warranted operative delivery of the preterm fetus with the attendant problems of prematurity. Delivery would have been hazardous in such an acutely unwell patient. The management also would have required magnesium sulfate with its potential for toxicity. Transient proteinuria may occur in status epilepticus. The blood pressure can be labile during epileptic seizures and, in the absence of an intracranial hemorrhage, generally settles without treatment after control of the seizures. This case highlights the importance of differentiating eclampsia in a patient with known epilepsy that may also mask other disease entities such as intracranial hemorrhage, meningitis, or encephalopathy. We have also discussed the importance of various signs associated with eclampsia and their clinical significance. The differential diagnosis of seizures in pregnancy are broad as symptoms of the various disease entities including eclampsia, intracranial hemorrhage, status epilepticus, meningitis, stroke overlap creating a dilemma in an acute emergency. We present a case whereby the clinical picture of status epilepticus was confused with eclampsia because of the presence of a rising blood pressure and proteinuria.

The Australian Register of Antiepileptic Drugs in Pregnancy: The first 1002 pregnancies

Prospective studies are needed to assess the maternal and fetal hazards of antiepileptic drug (AED) therapy in pregnancy. To make the Australian Register of AEDs in Pregnancy better known to the Australian obstetric community by presenting results derived from it. Analysis of data collected by the Register between 1999 and December 2006. The Register contained data on 1002 epileptic or AED-treated pregnancies, 992 with known outcomes, 83 not exposed to AEDs in at least their first trimester, and 30 prescribed AEDs for indications other than epilepsy. Statistically significant findings included more frequent folate supplementation and decreased alcohol intake during pregnancy in women with epilepsy; a dose-related increased risk of fetal malformation associated with valproate therapy; a tendency towards lower birthweights in live-born malformed offspring; and a substantially reduced decreased risk of seizures in pregnancy with one year seizure freedom before pregnancy. The small numbers of patients may have prevented other differences from reaching a P<0.05 value. The Register has already produced important information for the management of pregnant women with epilepsy in Australia, but greater rates of recruitment into the Register are desirable to allow it to achieve its full potential.