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Neurological Research and Practice

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Open Access 01-12-2024 | Status Epilepticus | Research article

Management of status epilepticus in pregnancy: a clinician survey

Authors: Dionne Swor, Pallavi Juneja, Charlotte Constantine, Catrin Mann, Felix Rosenow, Suzette LaRoche

Published in: Neurological Research and Practice | Issue 1/2024

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.

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Title: Management of status epilepticus in pregnancy: a clinician survey
Authors: Dionne Swor
Pallavi Juneja
Charlotte Constantine
Catrin Mann
Felix Rosenow
Suzette LaRoche
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Status Epilepticus
Epilepsy
Lacosamide
Phenytoin
Levetiracetam
Valproate
Phenobarbital
Phenobarbital
Eclampsia
Benzodiazepine
Published in: Neurological Research and Practice / Issue 1/2024
Electronic ISSN: 2524-3489
DOI: https://doi.org/10.1186/s42466-023-00295-z

2024 ASCO Annual Meeting

Springer Medicine

Management of status epilepticus in pregnancy: a clinician survey

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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