Recurrent seizures in pregnancy-epilepsy or eclampsia: a diagnostic dilemma? A case report

Peripartum seizure is a serious disease with substantial morbidity and mortality for the mother and fetus. Among various causes of such seizures, sometimes 2 causative factors can occur, simultaneously creating a dilemma in pharmacotherapeutic management. We describe a 34-weeks-pregnant woman with a history of epilepsy (receiving antiepileptic drugs) who had eclampsia and recurrent seizures in the peripartum period. Seizure control required multiple medications, including benzodiazepine, valproate, phenytoin, and magnesium sulfate. She underwent emergent cesarean delivery under general anesthesia to rescue the baby. Blood pressure control was achieved using alpha-methyldopa, labetalol, nitroglycerine, and amlodipine. Maximum vigilance is required for such patients, and therapy needs to be titrated according to patient's response, keeping in mind its impact on the fetus.