Status epilepticus in pregnancy: a literature review and a protocol proposal

ABSTRACT

Introduction

Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date.

Areas covered

In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach.

Expert opinion

Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulfate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.

KEYWORDS:

• Antiseizure medications
• eclampsia
• seizures
• magnesium sulfate
• benzodiazepines

Article highlights

• Prompt treatment of status epilepticus in pregnancy is paramount and a multidisciplinary team (i.e. experts in neurocritical care, epilepsy, gynecology) is needed.

• Available evidence on SE management in pregnancy are scarce and mainly derive from case reports and small case series.

• Magnesium sulphate is the first-line treatment during SE in eclampsia.

• Benzodiazepines are the drugs of choice for SE in pregnancy outside eclampsia. The most appropriate second-line agents are levetiracetam and phenytoin.

• Additional evidence is needed to propose a definite comprehensive approach.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded