The pharmacologic management of status epilepticus in pregnant patients: a scoping review

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-09-05 DOI:10.1002/jppr.1934

Emily M. Laswell PharmD, BCPS, David Peters Jr PharmD, BCCCP, Jordan Orchard PharmD

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Abstract

Background

Status epilepticus (SE) is defined as 5 min or more of seizure activity or two recurrent seizures without a return to baseline. Healthcare providers encounter a challenge when a patient with SE is pregnant. SE is not only detrimental to the mother but can also put the baby at risk of severe harm. SE must be treated rapidly and therefore healthcare providers have very little time to thoroughly review the risk and benefits of available antiseizure medication in this population.

Aim

To evaluate the current available evidence related to the management of SE in pregnancy.

Design

A literature search of PubMed, CINAHL, ProQuest Nursing & Allied Health Source, and Web of Science databases was conducted (2012–2022) using the following search terms: ‘pregnancy’, ‘pregnant women’ OR ‘gestation’ AND ‘status epilepticus’, ‘generalized status epilepticus’, ‘generalized convulsive status epilepticus’, ‘non convulsive status epilepticus’ OR ‘non-convulsive status epilepticus’. Full-text randomised controlled trials, clinical trials, observational studies, and case reports published in English were included. Data were extracted and the quality of the studies was evaluated using the Mixed Methods Appraisal Tool.

Results

The literature described 29 pregnancies and 30 total foetuses. Intravenous benzodiazepine use for emergent control was reported in 45% of patients. Phenytoin and levetiracetam were primarily utilised for urgent control, with a variety of agents used for refractory SE. Ninety-seven percent of maternal outcomes were reported as positive. The most common outcome was the birth of a healthy term infant. There were seven cases of pregnancy loss.

Conclusion

Publications pertaining to the treatment of SE in pregnancy are limited to case reports and small observational studies. Use of a benzodiazepine followed by levetiracetam or phenytoin is appropriate, whereas valproic acid should be utilised only when necessary due to the risk of major congenital malformation.

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妊娠患者癫痫状态的药物治疗：范围界定综述

背景癫痫状态（SE）的定义是发作活动持续 5 分钟或更长时间，或两次反复发作且未恢复到基线。当 SE 患者怀孕时，医疗服务提供者会遇到一个难题。SE 不仅对母亲有害，还可能使婴儿面临严重伤害的风险。SE 必须得到快速治疗，因此医疗服务提供者几乎没有时间来彻底审查抗癫痫药物在这一人群中的风险和益处。目的评估与妊娠期 SE 的治疗相关的现有证据。设计使用以下检索词对 PubMed、CINAHL、ProQuest Nursing & Allied Health Source 和 Web of Science 数据库进行文献检索（2012-2022 年）：妊娠"、"孕妇 "或 "妊娠 "和 "癫痫状态"、"全身性癫痫状态"、"全身性惊厥性癫痫状态"、"非惊厥性癫痫状态 "或 "非惊厥性癫痫状态"。研究对象包括用英语发表的全文随机对照试验、临床试验、观察性研究和病例报告。采用混合方法评估工具（Mixed Methods Appraisal Tool）提取数据并评估研究质量。结果文献中描述了 29 例妊娠和 30 个胎儿。据报道，45%的患者使用静脉注射苯二氮卓类药物进行紧急控制。苯妥英和左乙拉西坦主要用于紧急控制，各种药物用于难治性 SE。据报告，97%的孕产妇结果为阳性。最常见的结果是产下健康足月婴儿。有 7 例妊娠失败。结论有关治疗妊娠期 SE 的文献仅限于病例报告和小型观察性研究。在使用苯二氮卓类药物后再使用左乙拉西坦或苯妥英是合适的，而丙戊酸由于有导致重大先天性畸形的风险，只有在必要时才能使用。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.