Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy.
Obstetrics and Gynecology Unit, "Pugliese-ciaccio" Hospital of Catanzaro, Catanzaro, Italy.
Expert Rev Neurother. 2022 Apr;22(4):301-312. doi: 10.1080/14737175.2022.2057224. Epub 2022 Apr 7.
Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date.
In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach.
Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulfate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.
妊娠相关性癫痫持续状态（SE）对母亲和胎儿都是危及生命的医学急症。与妊娠相关的药代动力学改变，以及抗癫痫药物（ASM）和麻醉药物使用相关的胎儿风险，使 SE 的管理复杂化。目前尚无针对妊娠 SE 的标准化治疗方案。
在这篇综述中，我们概述了当前关于妊娠 SE 管理的文献，并提出了一种多学科为基础的方案方法。
文献数据稀缺（主要是轶事病例报告或小病例系列）。妊娠期间 SE 的及时治疗至关重要，需要多学科团队参与。苯二氮䓬类药物是妊娠 SE 的首选药物。左乙拉西坦和苯妥英是最合适的二线药物。如果其他 ASM 失败，应仅给予丙戊酸，且最好避免在妊娠早期使用。对于难治性 SE，需要使用麻醉药物，首选丙泊酚和咪达唑仑。硫酸镁是子痫相关性 SE 的一线治疗药物。如果全身麻醉失败，建议通过分娩或流产终止妊娠。需要进一步研究以确定最安全有效的治疗方案。
