Neurologic issues in eclampsia

Preeclampsia/eclampsia is a complex multisystem disorder with potentially severe, irreversible sequelae. Much of the morbidity involves the central nervous system. Neurologists can make important contributions to the management of eclampsia. In consultation with their obstetric colleagues they can provide input to the investigation of intracerebral vascular events, the management of seizures and raised intracranial pressure. Particularly in the case of eclampsia at early gestational ages, input on the severity and nature of the neurologic problem will assist the obstetrician in determining whether to expedite or delay delivery. Recent multicenter studies show a benefit of magnesium sulfate over either phenytoin or diazepam in the prevention of seizures, but questions about the conclusions remain. More basic and clinical research is needed, particularly on the pathophysiology of seizures and eclamptic vasospastic components, in order to provide a better understanding and consequently to design optimal therapy. The challenge includes finding an appropriate animal model for this disease with which to test such therapies.