Peripartum Status Epilepticus: Twitching with a Twist

Abstract

What are the initial priorities in managing a patient presenting with active seizures? AnswerWhen a patient comes with a seizure, initial attention, as always, should be given to the airway, breathing, and circulation, along with attempts to immediately control seizures. Airway management includes assessment of the airway for potential obstruction, aspiration, and protecting the airway with lateral decubitus position, suctioning of secretion, and securing the airway with intubation if it is threatened. Rapid sequence intubation should be the standard of care for airway intubation, with a more experienced airway manager performing the intubation. Care should be taken to prevent hemodynamic instability during intubation, with efforts to optimize, preload, and use vasopressors. Control of seizures and evaluation for the same should occur simultaneously. Prompt cessation of seizures is very important and should be achieved as early as possible since seizures tend to become refractory and lead to long-term adverse neurological Case DisCussion Case DescriptionA 39-year-old female with no past medical history presented elsewhere following a generalized tonic-clonic seizure on her 35th week of gestation. She was G2P1L1A1, and her antepartum period was complicated by hypothyroidism and gestational diabetes. There was no other significant obstetric history.