Indian Journal of Critical Care Case Report

Register      Login

VOLUME 1 , ISSUE 3 ( November-December, 2022 ) > List of Articles


Peripartum Status Epilepticus: Twitching with a Twist

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.

  1. Bhatia P, Chhabra S. Physiological and anatomical changes of pregnancy: implications for anaesthesia. Indian J Anaesth 2018;62(9):651–657. DOI: 10.4103/ija.IJA_458_18
  2. Koukoubanis K, Prodromidou A, Stamatakis E, et al. Role of critical care units in the management of obstetric patients (review). Biomed rep 2021;15(1):58. DOI: 10.3892/br.2021.1434
  3. Emergency Management of Status Epilepticus | EM Cases [Internet]. 2019 [cited 2022 Oct 20]. Available from:
  4. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol 2020;135(6):e237–e260. DOI: 10.1097/aog.0000000000003891
  5. Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr 2016;16(1):48–61. DOI: 10.5698/1535-7597-16.1.48
  6. Kim D, Kim JM, Cho YW, et al. Antiepileptic drug therapy for status epilepticus. J Clin Neurol 2021;17(1):11–19. DOI: 10.3988/jcn.2021.17.1.11
  7. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain 2011;134(10):2802–2818. DOI: 10.1093/brain/awr215
  8. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012;17(1):3–23. DOI: 10.1007/s12028-012-9695-z
  9. Valim V, Trevisani VFM, Pasoto SG, et al. AB0533 recommendations of Brazilian society of rheumatology for the treatment of Sjögren's syndrome. Ann Rheum Dis 2015;74(Suppl 2):1078. DOI: 10.1136/annrheumdis-2015-eular.4998
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.