Multiple Daily Seizures in a Pregnant Woman - A Case Report

Author(s): Ganesan Vivek1, Biju C. Nair2, Ayappan K.3, Riyaz A.4

A seizure is a brief disturbance of cerebral function, lasting from seconds to a few
minutes, caused by an abnormal electrical discharge. Epilepsy is the tendency to
have seizures on a chronic, recurrent basis, not resulting from a temporary
condition. The term, epilepsy, does not presuppose a cause; there are many
causes. Essentially, anything that disturbs the normal functioning of the cerebral
cortex can cause seizures, and if this abnormality is enduring, it can result in
epilepsy.1 Epilepsy is a common neurological condition with a global prevalence of
1.2 %. Most women with epilepsy who become pregnant or are planning to
conceive are recommended to continue taking antiepileptic drugs (AEDs) to
minimise seizure recurrence during pregnancy, adverse effects to the fetus, and
unintended ill consequences during labour and / or delivery.2,3 The seizure pattern
during pregnancy may be influenced by variations in ovarian hormones, blood
levels of antiepileptic drugs, and metabolic changes.4
Status epilepticus occurs in only 1 – 2 % of pregnancies,5 and if treated
appropriately and aggressively carries a fairly low risk of morbidity and mortality.
Structural and metabolic changes may precipitate new-onset seizures during
pregnancy. The structural causes include intracranial haemorrhage of multiple
types, cerebral venous sinus thrombosis, and ischemic stroke. Metabolic causes
include hyperemesis gravidarum; acute hepatitis (due to fatty liver of pregnancy
or viral hepatitis); metabolic diseases, such as acute intermittent porphyria;
infections, such as malaria; and eclampsia.5 Evaluation and management should
be performed in a stepwise fashion and may require a multidisciplinary approach
with other specialties such as neurology.6 The threat of seizures during pregnancy
and the consequences that they might have on the developing foetus are
fundamental reasons for the prescription of daily antiepileptic medication to a
pregnant woman with epilepsy (WWE).7 We present an original case of 3 episodes
of seizures, of 22-year-old female who was 16 weeks pregnant. This study was
approved by Sree Uthradom Thirunal Hospital, Pattom, Trivandrum, Kerala (ethics