Treatment of Seizures Related to Eclampsia: A Multi-Center Retrospective Analysis, 1995-2015 (I5.009)

Objective: To identify factors associated with treatment with antiepileptic drugs (AEDs), in addition to magnesium sulfate (MgSO4), in women with eclamptic seizure. Background: Treatment of seizures attributed to eclampsia varies and is inconsistent. Best available evidence demonstrates that MgSO4 is superior to AEDs in the management of eclamptic seizures. However, AEDs are often prescribed. Design/Methods: Cases with clear documentation attributing seizure activity to eclampsia from 1995-2015 at two large urban academic medical centers were identified using ICD-9 codes and reviewed by a neurologist and obstetrician. Demographics and other potential covariates were analyzed, including the presence of prodromal symptoms prior to seizure activity, history of epilepsy or migraines, formal neurology consultation, and posterior reversible encephalopathy syndrome (PRES) on neuroimaging. Analyses focused on patterns of AED utilization among women with single versus multiple seizures with sub-analysis of initial seizure occurring antepartum or postpartum. Continuous and categorical variables were analyzed with student’s t-test, chi-square, and Fisher’s exact test. Adjusted odds ratios were calculated using logistic regression. Results: Of 93 cases of eclamptic seizures, 90 had complete data including treatment regimen. Overall, women with >1 seizure were more likely to receive an AED in addition to MgSO4 (OR 3.27 [95[percnt] confidence interval (CI) 1.38-7.76]). The likelihood of receiving AEDs was further increased in women with >1 seizure in the postpartum setting (OR 4.6 [95[percnt] CI 1.1-19.14]). Women with >1 seizure were also more likely to have a history of migraines, PRES on neuroimaging, and seizure activity postpartum. Discussion: In this retrospective cohort, women with >1 eclamptic seizure were more likely to receive an AED, especially if the first seizure occurred postpartum. Further prospective research is needed to determine the significance of this trend, particularly in the prevention of recurrent seizures in the antepartum/postpartum settings. Disclosure: Dr. Deck has nothing to disclose. Dr. Yarrington has nothing to disclose. Dr. Hoch9s spouse holds stock and/or stock options in Merck, Biogen Idec, and Regeneron. Dr. McElrath has nothing to disclose. Dr. Pennell has nothing to disclose.