Christiana Andrew, Della Torre Micaela, Serafini Anna
University of Illinois Hospital & Health Sciences System, 1740 w Taylor St, Chicago, IL 60612, USA.
Epilepsy Behav Rep. 2021 Sep 15;16:100483. doi: 10.1016/j.ebr.2021.100483. eCollection 2021.
The management of women with epilepsy (WWE) presents many challenges for physicians. The primary goal during pregnancy is to achieve the best possible control of seizures with the least adverse effects associated with exposure to antiseizure medications (ASMs). Even though the guidelines for managing pregnant WWE are expanding, no definitive guidelines exist for the treatment of status epilepticus (SE). Additionally, much of our data comes from the effect of generalized tonic clonic seizures on the fetus. There is very little data on the effect of focal seizures and even less on focal SE. Here we present two cases of pregnant WWE who presented in focal SE, who underwent simultaneous video-EEG monitoring and fetal heart tracing (FHT). During each focal seizure the FHT demonstrated a normal baseline heart rate with moderate variability. In the second case due to continuous seizures more aggressive treatment had to be started. This led to maternal relative autonomic instability as well as absent variability on FHT. These findings raise many questions on the management of focal SE during pregnancy including if the effect of treatment is worse than the seizures, and how do we balance our goals for both mother and fetus?
癫痫女性患者（WWE）的管理给医生带来了诸多挑战。孕期的主要目标是在使用抗癫痫药物（ASM）产生最少不良反应的情况下，尽可能地控制癫痫发作。尽管管理孕期WWE的指南在不断扩展，但对于癫痫持续状态（SE）的治疗尚无明确指南。此外，我们的许多数据来自全身性强直阵挛发作对胎儿的影响。关于局灶性发作的影响的数据非常少，而关于局灶性SE的影响的数据更少。在此，我们介绍两例孕期WWE出现局灶性SE的病例，她们同时接受了视频脑电图监测和胎儿心率监测（FHT）。在每次局灶性发作期间，FHT显示基线心率正常，有适度的变异性。在第二例病例中，由于癫痫持续发作，不得不开始更积极的治疗。这导致了母亲相对自主神经不稳定以及FHT上变异性消失。这些发现引发了许多关于孕期局灶性SE管理的问题，包括治疗效果是否比发作更糟，以及我们如何平衡对母亲和胎儿的目标？
