EC Gynaecology

Seizures that arise with no abnormal electrical brain activity are known as Psychogenic Non-Epileptic seizures (PNES) or functional seizures (FS). They are described as physical symptoms triggered by extreme or intense emotions or stress. Eclampsia is a condition presenting with seizures in pregnancy complicated by pre-eclampsia. In non- epileptic pregnant women who have pregnancy induced hypertension or pre-eclampsia, any seizures would raise an immediate suspicion of eclampsia and would be managed with eclampsia protocol until otherwise proven. We are presenting a case of a 25-year old primiparous Caucasian woman who had an emergency caesarean delivery for severe pregnancy induced hypertension. She then presented on postoperative day seven feeling unwell with focal seizure like episodes with elevated blood pressure. Initially started on MgSO₄ protocol for eclampsia. On the background of fairly normal blood picture and imaging studies including EEG and CT head and BP remaining well controlled with antihypertensive medication, the woman continued to have seizure like episodes whilst on MgSO₄. Neurological specialist team were involved to have a multidisciplinary approach who then classified it as Functional Seizures (FS). Key focus for FS is to address the trigger factors. Cornerstone of treatment includes Cognitive behavioral therapy, insight-oriented therapy and practicing mindfulness. The woman reported that sleep deprivation, stressful postnatal period with experience of being a new mum, anxiety and exhaustion were possible triggers. In addition to this was a childhood history of an intentional overdosing with medications, secondary to long-term bullying in school that led to emergency admission to hospital, prolonged hospital stay and then was followed up by mental health services. She mentioned the postnatal stay in hospital gave her flashbacks of her past and added to the stress levels. Hence identifying these triggers and helping with Cognitive behavioral therapy, sleep hygiene, hydration and mindfulness were helpful in her management. At the neurology follow up appointment, patient did confirm better quality of sleep and stable mental health and no further seizure like episodes and has remained well for 20 months now.

 Keywords: Pregnancy and Functional Seizures; Postpartum Seizures; Non-Eclamptic Seizures; Seizures in Pregnancy; Non-Epileptic Seizures in Pregnancy; Psychogenic Seizures in Pregnancy and Postpartum; Postpartum Non-Epileptic Fits

1. DeToledo JC., et al. “Nonepileptic seizures in pregnancy”. Neurology 1 (2000): 120-121.
2. Dworetzky BA., et al. “A clinically oriented perspective on psychogenic nonepileptic seizure-related emergencies”. Clinical EEG and Neuroscience1 (2015): 26-33.
3. Christina Catherine., et al. “High Rates of Pregnancy Complications in Patients with Functional Seizures” (2024).
4. Non-epileptic seizures and functional (dissociative) seizures. https://epilepsysociety.org.uk/about-epilepsy/what-epilepsy/non-epileptic-seizures
5. Asadi-Pooya AA., et al. “Functional seizures are not less important than epilepsy”. Epilepsy and Behavior Reports 16 (2021): 100495.
6. Magley M and Hinson MR. “Eclampsia”. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2024).
7. Jain U., et al. “Psychogenic non-epileptic seizures in a second-trimester pregnant woman with a previous child loss”. Primary Care Companion for CNS Disorders 6 (2013): PCC.13l01562.
8. Nnamani NP., et al. “For the Parturient, All that Seizes is not Eclampsia. A Review of Psychogenic Non-Epileptic Seizures in Pregnancy”. JSM Clinical Anesthesiology 1 (2019): 5.
9. Vijay M and Reuber M. “An update on psychogenic nonepileptic seizures”. Current Opinion in Neurology 2 (2024): 121-126.
10. Cipolla MJ and Kraig RP. “Seizures in women with preeclampsia: mechanisms and management”. Fetal and Maternal Medicine Review2 (2011): 91-108.