title: Seizures in the peripartum period: Epidemiology, diagnosis and management.
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 MgSO4therapy are discussed, as well as controversies on the alteration of these regimens and the use of MgSO4in 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.
authors.affiliation: Department of anesthesiology and pain medicine, Caremeau university hospital, place du Pr.-Debré, 30029 Nîmes cedex 09, France; Research group EA2992, Montpellier-Nîmes university, Nîmes, France. Electronic address: antoine.aya@chu-nimes.fr.
authors.forename: A G M
authors.initials: AG
authors.lastname: Aya
authors.affiliation: Neurology service, Layné hospital, avenue Pierre-de-Coubertin, 40024 Mont-de-Marsan, France.
authors.forename: B
authors.initials: B
authors.lastname: Ondze
authors.affiliation: Department of anesthesiology and pain medicine, Caremeau university hospital, place du Pr.-Debré, 30029 Nîmes cedex 09, France; Research group EA2992, Montpellier-Nîmes university, Nîmes, France.
authors.forename: J
authors.initials: J
authors.lastname: Ripart
authors.affiliation: Department of anesthesiology and pain medicine, Caremeau university hospital, place du Pr.-Debré, 30029 Nîmes cedex 09, France; Research group EA2992, Montpellier-Nîmes university, Nîmes, France.
authors.forename: P
authors.initials: P
authors.lastname: Cuvillon
mesh_terms: D000328:Adult; D004461:Eclampsia / Q000628:therapy; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
keywords: CRVS; Cerebral venous thrombosis; Eclampsia; PRES; Purpura; Seizures