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PRACTICE: Torbjörn Tomson and Vilho Hiilesmaa Epilepsy in pregnancy BMJ 2007; 335: 769-773 [Full text]

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Epilepsy in pregnancy.

S. Nizam Ahmed   (15 October 2007)

Status in pregnancy

Andrew J Larner   (19 October 2007)

Epilepsy in pregnancy. 15 October 2007
S. Nizam Ahmed, Neurologist University of Alberta, Canada T6G2B7 Send response to journal: Re: Epilepsy in pregnancy.	The article by Tomson and Hiilesmaa (1) provides a nice summary outlining the problems and management of women in epilepsy. The authors probably overlooked the recommendation by the American Academy of Neurology's guidelines on women with epilepsy suggesting supplementing patients on enzyme inducing antiepileptic drugs with vitamin K (2). 1. Tomson T, Hiilesmaa. Epilepsy in pregnancy. BMJ. October 13 2007. Volume 335 2. Neurology 1998;51:944-948. Competing interests: None declared
Status in pregnancy 19 October 2007
Andrew J Larner, Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool, UK Send response to journal: Re: Status in pregnancy	Tomson & Hiilesmaa suggest that "refractory status epilepticus in the third trimester of pregnancy could be an indication for a caesarean". This may be true, but one potential pitfall which needs to be considered in this situation is pseudostatus epilepticus in pregnancy. Such a case in which emergency caesarean was considered prior to correct diagnosis has been reported.1 Although published cases are few,2 and the true incidence is unknown, it should be borne in mind that pseudostatus epilepticus occurs predominantly in women of childbearing age, and is commoner than true status epilepticus in specialised neurological practice. Presentation during pregnancy may put the fetus at “double jeopardy”: on the one hand from cyanosis associated with the seizures which may be associated with fetal hypoxia, necessitating respiratory support and the attendant complications of sedation; and on the other hand, from the understandable anxiety that seizures may reflect neurological complications of eclampsia, requiring prompt operative delivery of the fetus with the attendant risks of prematurity. Hence, this is a condition which both obstetricians and neurologists need to be aware of. References 1/ Peters G, Leach JP, Larner AJ. Pseudostatus epilepticus in pregnancy. Int J Gyneacol Obstet 2007;97;47. 2/ Smith PEM, Saunders J, Dawson A, Kerr MP. Intractable seizures in pregnancy. Lancet 1999;354:1522. Competing interests: None declared