Status epilepticus associated with pregnancy: A cohort study

Area of Science:

• Neurology
• Obstetrics
• Critical Care Medicine

Background:

• Status epilepticus (SE) is a critical neurological emergency with high mortality and significant long-term cognitive effects.
• Pregnancy-associated SE presents unique challenges for diagnosis and treatment, posing risks to both mother and fetus.
• Limited data exists on the prevalence, causes, and outcomes of SE during pregnancy.

Purpose of the Study:

• To investigate the characteristics, etiologies, and outcomes of pregnancy-related status epilepticus.
• To identify risk factors and potential causes of de novo SE in pregnant patients.
• To inform clinical management strategies for improving maternal and fetal outcomes.

Main Methods:

• Retrospective analysis of 366 SE episodes over 8.5 years in a neurological ICU.
• Identification of pregnancy-related SE cases occurring during pregnancy or within 6 months postpartum.
• Exclusion of eclampsia cases, typically managed in obstetric units.

Main Results:

• Seven cases (2.1% of total SE) of pregnancy-related SE were identified.
• The majority (85%) of cases were de novo SE, with limbic encephalitis and cerebral venous sinus thrombosis as primary etiologies.
• An overall mortality rate of 28.5% was observed, with poorer outcomes in patients with limbic encephalitis.

Conclusions:

• Pregnancy-associated SE is infrequent and often occurs in women without prior epilepsy history.
• Autoimmune etiologies, particularly limbic encephalitis, should be suspected in pregnant patients with de novo SE due to associated poor outcomes.
• Timely, etiology-guided investigations and interventions are crucial for enhancing maternal and fetal prognoses.