VOLUME 1 , ISSUE 3 ( November-December, 2022 ) > List of Articles
Dinesh Krishnamoorthy, Vignesh Chandrasekaran
Keywords : Eclampsia, Epilepticus, Gestation, Peripartum, Primary brain infections
Citation Information : Krishnamoorthy D, Chandrasekaran V. Peripartum Status Epilepticus: Twitching with a Twist. 2022; 1 (3):75-78.
DOI: 10.5005/jp-journals-11006-0025
License: CC BY-NC 4.0
Published Online: 02-01-2023
Copyright Statement: Copyright © 2022; The Author(s).
Case description: A 39-year-old woman, gestation twice and one birth, that is, one live delivery and one abortion after an unplanned pregnancy (G2P1L1A1) in her 35th week of gestation presented with an episode of seizure followed by unconsciousness. Course of treatment: After securing her airway, her pregnancy was terminated, and she was treated with anti-seizure medications. She then progressed to refractory status epilepticus (RSE). Eclampsia and primary brain infections were ruled out. Magnetic resonance imaging (MRI) of the brain showed hyperintensities in the bilateral hippocampus and medial temporal lobes. With electroencephalogram (EEG) guidance, seizures were controlled with intravenous (IV) anesthetic agents, in addition to seven antiepileptic medications. After ruling out infective etiology, pulse dose steroid therapy and plasma exchange were initiated. However, her autoimmune encephalitis workup turned up to be negative. On further evaluation, her antinuclear antibodies (ANA) and extractable nuclear antigen (ENA) profiles were positive for ANA, anti-Sjögren's-syndrome-related antigen A autoantibodies (anti-Ro) 52, anti-Ro/SSA, and anti-La/SSB. A diagnosis of primary neuro Sjögren's syndrome was made. In view of persistent seizures despite high dose steroid and plasma exchange therapy, IV cyclophosphamide was initiated. Subsequently, the IV anesthetic agents were weaned off. On weaning of IV anesthetics, she was conscious and oriented and then weaned off ventilation gradually. She was then discharged with oral steroids and oral antiepileptics. Conclusion: RSE can be a rare initial presentation of primary Sjögren's syndrome.