Management of status epilepticus in pregnancy: a clinician survey

Dionne Swor; Pallavi Juneja; Charlotte Constantine; Catrin Mann; Felix Rosenow; Suzette LaRoche

doi:10.1186/s42466-023-00295-z

Management of status epilepticus in pregnancy: a clinician survey

Neurol Res Pract. 2024 Jan 18;6(1):3. doi: 10.1186/s42466-023-00295-z.

Authors

Dionne Swor¹, Pallavi Juneja², Charlotte Constantine³, Catrin Mann⁴, Felix Rosenow⁴, Suzette LaRoche⁵

Affiliations

¹ Department of Neurology, University of Toledo, Toledo, USA. dionne.swor@utoledo.edu.
² Department of Neurology, Columbia University, New York, USA.
³ Worcester Academy, Worcester, USA.
⁴ Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.
⁵ Department of Neurology, University of North Carolina, Chapel Hill, USA.

Abstract

Background: Status epilepticus in pregnancy (SEP) is rare and life-threatening for both mother and fetus. There are well-established guidelines for the management of women with epilepsy during pregnancy; however, there is little evidence guiding the management of SEP, leading to uncertainty among treating physicians. Therefore, this survey aims to investigate the real-world practices of physicians treating SEP to explore management approaches for improvements in care.

Methods: An anonymous, electronic survey was created and distributed to neurointensivists and neurologists between September and December 2021.

Results: One hundred physicians initiated the survey and 95 completed it in full: 87 (87%, 87/100) identified neurology as their primary specialty, 31 had subspecialty training in neurocritical care, and 48 had subspecialty training in epilepsy and/or clinical neurophysiology. Over half of the survey respondents (67%, 67/100) reported having participated in the management of SEP, with 48.9% (49/98) having done so in the past year. Most survey respondents (73%, 73/100) reported that their management approach to SEP is different than that of non-pregnant patients. Survey respondents were more likely to involve epilepsy consultants when treating SEP (58.5%, 58/99) and the vast majority involved Obstetrics/Maternal Fetal Medicine consultants (90.8%, 89/98). Survey respondents showed a clear preference for levetiracetam (89.7%, 87/97) in the treatment of benzodiazepine refractory status epilepticus followed by lacosamide (61%, 60/98) if an additional second line agent was needed. Valproate and phenobarbital were unlikely to be used. There was less agreement for the management of refractory and super-refractory SEP.

Conclusions: Levetiracetam is the most frequently used anti-seizure medication (ASM) for benzodiazepine-refractory SEP. Survey participants tended to manage SEP differently than in non-pregnant patients including greater involvement of interdisciplinary teams as well as avoidance of ASMs associated with known teratogenicity.

Keywords: Acute seizures; Anti-seizure medication; New onset status epilepticus in pregnancy; Status epilepticus in pregnancy; Women with epilepsy.