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

Seizure is the Great Masquerader in the Peripartum Period

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

Background

• 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

Poster Presenter

Authors

Affiliations

Part of Topic

2026 SOAP Annual Meeting

Seizure is the Great Masquerader in the Peripartum Period

Poster Presenter

Authors

Affiliations

Part of Topic