Seizures in the peripartum period: Epidemiology, diagnosis and management - 30/09/16
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Abstract |
The occurrence of seizures in the peripartum period is a rare but particularly challenging situation. Seizures in the peripartum period could result from three categories of conditions: first and most frequent is the exacerbation of a known pre-existing seizure disorder, mainly epilepsy. A therapeutic evaluation is needed; second is the new onset of seizures due to a non-pregnancy-related problem. An accurate diagnosis and a specific treatment are required; third is range of pregnancy-related conditions. The present review focuses on this third category, with a special attention to disorders occurring in the peripartum period. It is structured in two sections. The first section is a focus on eclampsia since, based on ICU admission data, it appears to be the leading cause of pregnancy-related seizures. Its epidemiology, pathophysiology, clinical diagnosis, neuro-imaging features and recommended management are reviewed. The efficacy and safety of the recommended regimens of MgSO4 therapy are discussed, as well as controversies on the alteration of these regimens and the use of MgSO4 in women with mild preeclampsia. In the second section, the other causes of pregnancy-related new onset seizures are summarized. These include posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, thrombotic thrombocytopenic purpura, amniotic fluid embolism, and air embolism. Noteworthy is the fact that most of these pregnancy-related seizure conditions overlap with each other, mainly in terms of clinical presentations and neuro-imaging. Therefore, the diagnosis and the treatment options should be considered on a multidisciplinary basis.
Le texte complet de cet article est disponible en PDF.Keywords : Seizures, Eclampsia, CRVS, PRES, Cerebral venous thrombosis, Purpura
Plan
☆ | Article presented at Monothematic meeting of Société française d’anesthésie et de reanimation (Sfar) : “Urgence, anesthésie et reanimation de la femme enceinte”, Paris, May 16, 2016. |
☆☆ | This article is published under the responsability of the Scientific Committee of the “Journée monothématique 2016 de la Sfar”. The editorial board of the Anaesthesia critical care & pain medicine was not involved in the conception and validation of its content. |
Vol 35 - N° S1
P. S13-S21 - octobre 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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