Seizures in Women with Preeclampsia: Mechanisms and Management.

Eclampsia is defined in the obstetrical literature as the occurrence of unexplained seizure during pregnancy in a woman with preeclampsia.1,2 In the Western world, the incidence of eclampsia is ∼1 per 2000 to 1 per 3000 pregnancies3–5, but the incidence is 10-fold higher in tertiary referral centers and undeveloped countries where there is poor prenatal care, and in multi-fetal gestations.6,7 Nearly 1 in 50 women with eclampsia die as do 1 in 14 of their offspring, and mortality rates are considerably higher in undeveloped countries.3,8,9 Eclampsia is also associated with significant lifethreatening complications, including neurological events. Seizure acutely can cause stroke, haemorrhage, oedema and brain herniation10–13 and thus lead to epilepsy and cognitive impairment later in life.13,14 Preeclampsia is by definition a prodrome for eclampsia, making hypertension and proteinuria prerequisite for seizure during pregnancy. However, women who develop eclampsia exhibit a wide spectrum of signs and symptoms ranging from severe hypertension and proteinuria to mild or absent hypertension with no proteinuria.6,9,15 In a study of 53 pregnancies complicated by eclampsia, only 7 women (13%) could be considered to have severe preeclampsia prior to seizure.15 A similar result was found in a United Kingdom study in which high blood pressure (≥120 mmHg diastolic) was recorded in only 20% of patients with eclampsia.3 The finding that a fair number of women with eclampsia do not fulfill the clinical definition of hypertension or proteinuria suggests eclampsia is not always a progression from severe preeclamptic disease to seizure. While this alternative view of the eclamptic seizure was presented over 10 years ago, there has been little progress in understanding the underlying cause of eclampsia.3 While eclampsia remains a life-threatening complication of pregnancy, there are no reliable tests or symptoms for predicting the development of seizure. Magnesium sulfate (MgSO4) is the primary treatment in preeclamptic women for prevention