2026 SOAP Annual Meeting

Seizure is the Great Masquerader in the Peripartum Period

Patricia Rusli, MD ; Becky Mirsky, MD ; Goran Ristev, MD

Background

• IntheUnitedStates,epilepsyaffect1.1millionwomenofchildbearingage.
• 15–30%parturientwithhistoryofepilepsymayexperienceanincreaseinseizures. • Theyalsohaveafour-foldsignificantlyhigherriskofdeath.

• Differential diagnosis:

• Intracranialhemorrhage,cerebralvenoussinusthrombosis,ischemicstroke, eclampsia, infection, and local anesthetic systemic toxicity.

Case Presentation

• 34 years-old G3P2002 at 39 weeks and 3 days gestation presenting for repeat Cesarean delivery.

HPI

Idiopathic epilepsy
Prior cesarean delivery
Epilepsy clinic:

• Increased Levatiracetam

• Avoid phenylephrine, diphenhydramine

Cesarean Delivery

Spinal Anesthesia
Norepinephrine as vasopressor
Tonic-clonic seizures post-delivery
Conversion to general anesthesia
Midazolam and magnesium sulfate
Extubation at the end of the case

Work-up

•Laboratory test: liver function tests, urinalysis and platelet count

•History from patient •Assessment of patient

Figure 1. Brain Venogram Figure 2. Brain MRI

Summary - Learning Points

• Comprehensive Perioperative planning

• Medication management • Patient education

• Prompt differentiation from other pathologies

• Medical history

• Laboratory testing and imaging as indicated

• Key anesthetic considerations • Airway management

• Medication management

2026 SOAP Annual Meeting

Seizure is the Great Masquerader in the Peripartum Period

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