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Multiple Daily Seizures in a Pregnant Woman - A Case Report

A seizure is a brief disturbance of cerebral function, lasting from seconds to a few minutes, caused by an abnormal electrical discharge. Epilepsy is the tendency to have seizures on a chronic, recurrent basis, not resulting from a temporary condition. The term, epilepsy, does not presuppose a cause; there are many causes. Essentially, anything that disturbs the normal functioning of the cerebral cortex can cause seizures, and if this abnormality is enduring, it can result in epilepsy.1 Epilepsy is a common neurological condition with a global prevalence of 1.2 %. Most women with epilepsy who become pregnant or are planning to conceive are recommended to continue taking antiepileptic drugs (AEDs) to minimise seizure recurrence during pregnancy, adverse effects to the fetus, and unintended ill consequences during labour and / or delivery.2,3 The seizure pattern during pregnancy may be influenced by variations in ovarian hormones, blood levels of antiepileptic drugs, and metabolic changes.4 Status epilepticus occurs in only 1 – 2 % of pregnancies,5 and if treated appropriately and aggressively carries a fairly low risk of morbidity and mortality. Structural and metabolic changes may precipitate new-onset seizures during pregnancy. The structural causes include intracranial haemorrhage of multiple types, cerebral venous sinus thrombosis, and ischemic stroke. Metabolic causes include hyperemesis gravidarum; acute hepatitis (due to fatty liver of pregnancy or viral hepatitis); metabolic diseases, such as acute intermittent porphyria; infections, such as malaria; and eclampsia.5 Evaluation and management should be performed in a stepwise fashion and may require a multidisciplinary approach with other specialties such as neurology.6 The threat of seizures during pregnancy and the consequences that they might have on the developing foetus are fundamental reasons for the prescription of daily antiepileptic medication to a pregnant woman with epilepsy (WWE).7 We present an original case of 3 episodes of seizures, of 22-year-old female who was 16 weeks pregnant. This study was approved by Sree Uthradom Thirunal Hospital, Pattom, Trivandrum, Kerala (ethics committee).