Review Status epilepticus in pregnancy – Can we frame a uniform treatment protocol? Keni Ravish Rajiv, Ashalatha Radhakrishnan ⁎ R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, SreeChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India abstract article info Article history: Received 9 May 2019 Accepted 11 June 2019 Available online xxxx Background: There is lack of uniform treatment protocol for status epilepticus (SE) in pregnancy, with majority of data being limited to individual cases or case series. Devising a uniform treatment protocol will facilitate prompt control of SE in pregnancy and reduce adverse maternal and fetal outcomes. Methods: Literature search was done in various databases including PubMed, CINAHL, EMBASE, TRIP, and the gray literature, including relevant organizational websites, for the topics “Status Epilepticus” and “Pregnancy”. English language original research articles, case reports, and systematic reviews that were published in the last 18 years (2000–2018) and addressed SE in relation to pregnancy (i.e., antepartum, labor, or postpartum) were considered for inclusion. Results: Over the past 15 years, a total of seven articles reporting 29 cases of SE related to pregnancy, satisfying the inclusion criteria were analyzed. The most common cause of SE was posterior reversible encephalopathy syn- drome (PRES)/reversible cerebral vasoconstriction syndrome (RCVS) spectrum (n = 11, 38%), followed by cor- tical venous sinus thrombosis (CVT) and autoimmune encephalitis (n = 5, 17%). Twenty-three out of 29 cases (79%) had good maternal outcomes in terms of recovery to baseline. Seventeen fetuses (58%) were delivered at term and seven at preterm (2.4%). First-line agent used was lorazepam in 15 patients (52%) and midazolam in two patients (7%). The most common antiepileptic drug (AED) and anesthesia used for treatment of SE and re- fractory SE were phenytoin/fosphenytoin (n = 21, 72%) and midazolam (n = 12, 52%), respectively. In all cases due to eclampsia (n = 5), magnesium sulfate was the preferred first-line drug. Conclusion: Management of SE in pregnancy is influenced by etiology of SE and duration of pregnancy. It carries a good prognosis if detected early and treated appropriately. Large-scale multicentric studies are warranted for for- mulating definite guidelines for management of SE in pregnancy. This article is part of the Special Issue “Proceedings of the 7th London-Innsbruck Colloquium on Status Ep- ilepticus and Acute Seizures”. © 2019 Elsevier Inc. All rights reserved. Keywords: Status epilepticus Pregnancy Guideline Outcome 1. Introduction Status epilepticus (SE) in pregnancy is rare and carries a significant risk to both mother and fetus. Based on available literature data, eclampsia is the most common etiology of SE, and various other diverse etiologies have also been implicated to be causing SE in pregnancy [1–8]. The challenge regarding management of SE in pregnancy lies in prompt control of SE, taking into consideration the safety and tolerabil- ity of antiepileptic drugs (AEDs) and anesthetic agents for control of SE. There is lack of uniform treatment protocol for SE in pregnancy, with majority of data being limited to individual or case series reports. With majority of patients being from the developing countries where the pa- tient is managed essentially by the obstetricians with lack of neurolog- ical expertise;, a uniform treatment protocol will facilitate prompt control of SE and reduce adverse maternal and fetal outcomes. 2. Methods We searched various databases including PubMed, CINAHL, EMBASE, TRIP, and the gray literature, including relevant organizational websites, for the topics “Status Epilepticus” and “Pregnancy”. English language original research articles, case reports, and systematic reviews that were published in the last 18 years (2000–2018) and addressed SE in relation to pregnancy (i.e., antepartum, labor, or postpartum) were considered for inclusion. Excluded were cases who had SE not related Epilepsy & Behavior xxx (xxxx) xxx Abbreviations: SE, Status epilepticus; AED, antiepileptic drug; PRES, posterior reversible encephalopathy syndrome; RCVS, reversible cerebral vasoconstriction syndrome; CVT, cortical venous sinus thrombosis; SAH, subarachnoid hemorrhage; MgSO4, magnesium sulfate. ⁎ Corresponding author at: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India. E-mail address: drashalatha@sctimst.ac.in (Radhakrishnan A.). YEBEH-06376; No of Pages 4 https://doi.org/10.1016/j.yebeh.2019.06.020 1525-5050/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: Rajiv KR, Radhakrishnan A, Status epilepticus in pregnancy – Can we frame a uniform treatment protocol?, Epilepsy & Behavior, https://doi.org/10.1016/j.yebeh.2019.06.020