R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Epilepsy Behav. 2017 Nov;76:114-119. doi: 10.1016/j.yebeh.2017.07.002. Epub 2017 Sep 9.
Status epilepticus (SE) in pregnancy carries significant risk to both mother and fetus. There is limited literature available on SE occurring in pregnancy world-over, with majority being from obstetric centers.
All women who developed SE related to pregnancy (gestation, labor, or puerperium) between January 2000 and December 2016 were included in the study. Data were collected from our SE registry, maintained, and archived in the institute. The variables influencing the maternal and fetal outcome were compared using Student's t-test for continuous variables and Fisher's exact test for discrete variables.
During the 16-year study period, a total of 348 SE events were recorded in 294 patients. Among these, there were 138 women, of which 17 had SE related to pregnancy. The etiology of SE was remote symptomatic in two and acute symptomatic in 15 patients. The various causes detected after initial evaluation for acute symptomatic SE were eclampsia (n=4), posterior reversible encephalopathy syndrome due to various causes other than eclampsia (n=6), cortical venous thrombosis (n=3), subarachnoid hemorrhage (n=1), and NMDA receptor antibody-mediated encephalitis (n=1).13 of 17 women with SE (76%) had good outcome. Majority of the fetuses had good outcomes, i.e., Category 1 (n=9, 57%). Duration of intensive care unit stay (p=0.029) and Status Epilepticus Severity Score (p=0.0324) at admission, were found to be significantly associated with poor outcomes.
In any patient presenting with SE occurring in pregnancy, though eclampsia is presumed to be the most common overall cause; it is relevant to consider other etiologies such as posterior reversible encephalopathy syndrome, cortical venous thrombosis, and autoimmune encephalitis especially in cases presenting with refractory SE. Posterior reversible encephalopathy may occur in pregnancy due to diverse etiologies other than eclampsia.
妊娠相关性癫痫持续状态（SE）对母婴均有重大风险。全世界范围内有关妊娠相关性 SE 的文献有限，大多数来自产科中心。
本研究纳入了 2000 年 1 月至 2016 年 12 月期间发生与妊娠（妊娠、分娩或产褥期）相关的 SE 的所有女性。数据来自我们的 SE 登记处，在研究所进行维护和存档。使用学生 t 检验比较连续变量和 Fisher 确切检验比较离散变量，以比较影响母婴结局的变量。
在 16 年的研究期间，共记录了 294 例患者中的 348 例 SE 事件。其中有 138 名女性，其中 17 例 SE 与妊娠有关。SE 的病因在 2 例为远隔症状性，15 例为急性症状性。在对急性症状性 SE 进行初步评估后发现的各种原因有子痫（n=4）、非子痫引起的后部可逆性脑病综合征（n=6）、皮质静脉血栓形成（n=3）、蛛网膜下腔出血（n=1）和 NMDA 受体抗体介导的脑炎（n=1）。17 例 SE 女性中有 13 例（76%）结局良好。大多数胎儿结局良好，即类别 1（n=9，57%）。入住 ICU 的时间（p=0.029）和入院时癫痫持续状态严重程度评分（p=0.0324）与不良结局显著相关。
在任何出现妊娠相关性 SE 的患者中，虽然子痫被认为是最常见的总体病因；但考虑到其他病因，如后部可逆性脑病综合征、皮质静脉血栓形成和自身免疫性脑炎，特别是在出现难治性 SE 的情况下，这是相关的。后部可逆性脑病可能因子痫以外的多种病因在妊娠中发生。
