Epilepsy and pregnancy]

Presented is a case of a 22-year-old pregnant woman in the ninth lunar month of pregnancy and with epilepsy from 10 years of age. The patient had been on therapy with barbiturates and carbamazepines for over ten years. She was hospitalized in the neurology department after having 5 grand mals in one day. After hospitalization she was observed to have Jackson-type feats of the left limbs that later on became generalized. In-between the feats she had left-sided reflector hemiparesis, and EEG data of an epileptic focus in the sensomotor region of the right hemisphere. The CT with contrast medium showed no pathologic changes. Sonography and cardiotocographic studies revealed no gross anomalies of the fetus, and adequate biometric data. Therapy was instituted with carbamazepin 0.200 t.i.d. valproate 0.200 t.i.d. and mannitol i.v. l/kg body weight. On the seventh day of therapy emergency c.s. was performed and a viable fetus weighing 2020 grams and in length 43 cm. was extracted. For three days after the operation the patient was on artificial ventilation. She was discharged on the twentieth day in a relatively good state and on maintenance therapy. The authors believe that the effect of pregnancy on epilepsy cannot always be foreseen. A precise titration of anticonvulsants to necessary for optimal control of epileptic feats during pregnancy.