Review Question - QID 103370

This patient with persistent headaches, seizure activity, and hypertension has eclampsia. Patients with eclampsia or pre-eclampsia should be treated with magnesium sulfate to reduce the risk of seizures.

Tonic-clonic seizures, also called eclamptic convulsions, are the hallmark of eclampsia. Such seizures typically occur once signs of pre-eclampsia, including hypertension and proteinuria, are already present. While not fully understood, pre-eclampsia and eclampsia are thought to develop due to abnormalities in the development of placental vasculature, along with the release of placental and maternal factors. By definition, pre-eclampsia is defined as the onset of hypertension and proteinuria or end organ dysfunction after 20 weeks of gestation. Pre-eclampsia and eclampsia may also occur up to several weeks after delivery. Magnesium sulfate is the treatment of choice for seizure prophylaxis in patients with eclampsia. Eclampsia is managed definitively with delivery of the baby and placenta.

Leeman et al. report that preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. The adverse pregnancy outcomes related to severe preeclampsia are caused primarily by the need for preterm delivery. Magnesium sulfate is the drug of choice to prevent and treat eclampsia.

Fogleman writes that magnesium sulfate is the treatment of choice for seizure prophylaxis in patients with pre-eclampsia and eclampsia because the medication prevents seizures without adverse affects to the soon to be born fetus at 18 months of age. The author notes that magnesium increases the risk of Cesarian section and side effects such as flushing as well as cardiac and respiratory depression.

Illustration A shows a treatment algorithm for patients with severe pre-eclampsia as recommended by Leeman et al.

Incorrect answers:
Answer 1: Carbemazepine is an anti-epileptic drug used in the management of some seizure disorders and trigeminal neuralgia. However, it is associated with risk of fetal cardiac malformaiton and neural tube defects. It is not indicated in the management of eclampsia.

Answer 2: Lamotrigine is an anti-epileptic drug used in the management of some seizure disorders. However, it is associated with particularly high risk of fetal neural tube defects. It is not indicated in the management of eclampsia.

Answer 3: Lorazepam is a benzodiazepine medication that is used to abort seizure activity. It is indicated in some patients with eclampsia who are actively seizing and have not responded to magnesium sulfate. However, it is not the most appropriate initial medication for this patient.

Answer 5: Phenobarbitol is a barbiturate medication that is used in the treatment of alcohol withdrawal and seizures. It is more commonly used for treatment of seizures in neonates. It is not indicated in the management of eclampsia.

Bullet Summary:
Patients with eclampsia or pre-eclampsia should be treated with magnesium sulfate to reduce the risk of seizures.