VANCOUVER, BC—Women with more than one eclampsia-related seizure are likely to be administered antiepileptic drugs (AEDs), according to a multicenter retrospective study reported in a poster presentation at the 68th ANN Annual Meeting. 

“In this retrospective cohort, women with >1 eclamptic seizures were more likely to receive an AED, especially if the first seizure occurred postpartum,” wrote lead study author Gina Deck, MD, of Massachusetts General Hospital in Boston, and coauthors. “Further prospective research is needed to determine the significance of this tree, and if the addition of AED to MgSO4 [magnesium sulfate] decreases the risk of recurrent seizures in the antepartum/postpartum settings.”

MgSO4 is the treatment of choice for women without eclampsia signs prior to first seizure. “However, treatment of seizures attributed to eclampsia continues to be inconsistent and varied,” the authors noted. Many women are also treated with AEDs.

In order to assess treatment patterns among these women, the coauthors searched databases at two large urban academic-medical centers for the records of patients who had eclampsia-related seizures between 1995 and 2015. Patient histories of epilepsy, migraines, neurological consults, and reversible encephalopathy syndrome (PRES) were collected, and patterns of AED administration were compared for women with one or multiple seizures, the research team reported.

A total of 93 women with eclamptic seizures were identified (50 with ante- or intra-partum first seizure and 43 with postpartum onset). All had received MgSO4 and approximately half (52%) were also administered AEDs. Reported symptoms before eclamptic seizures included headaches and visual symptoms.

“Women with more than one seizure were more likely to receive an AED in addition to MgSO4 (odds ratio [OR] 3.27; 95% CI 1.38–7.76),” the coauthors wrote.

“There was no significant correlation between the timing of eclamptic seizure or number of seizures and the decision to continue AEDs after discharge from the hospital,” they noted. “Women with postpartum eclampsia were more likely to have multiple seizures (P<0.05), get a neurology consultation (P<0.05), and to undergo neuroimaging (P<0.05).” 

Seventy-seven of the 93 women underwent neuroimaging. Among those women, imaging yielded evidence of PRES in 60% of cases, the coauthors reported.