Eclampsia and Risk of Recurrent Seizures

Gregory L. Krauss, MD

Disclosures

March 23, 2004

Question

Is a woman with a history of eclampsia at risk years later for a recurrent seizure unrelated to pregnancy? Is it advisable to avoid medicines known to lower seizure threshold in someone with a history of eclampsia, specifically bupropion?

Julia Kissel, MD

Response from Gregory L. Krauss, MD

Eclampsia is a syndrome of perinatal (> 90%) and postnatal (< 10%) tonic-clonic seizures in women with preeclampsia, a condition that includes hypertension, proteinuria, usually edema, and hyperreflexia.[1] Generalized seizures in eclampsia are associated with abnormal placental implantation, and 2% of women have recurring eclampsia. There is, however, no evidence that women with eclampsia are at risk for subsequent epilepsy. The one exception may be rare patients with eclampsia who suffer major cerebral injuries, such as hypertensive hemorrhage or complications of the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet syndrome count.[2,3] Even in these patients, epilepsy would be an uncommon complication.

Bupropion therapy, provided at recommended doses and particularly when uniform delivery "sustained release formulations (ie, bupropion hydrochloride) are used, has a low associated risk for seizures (approximately 0.1%) and therefore would not be contraindicated in a patient with previous eclampsia.[4]

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