Objective:

There is limited literature documenting risks and pregnancy outcomes in mothers with functional seizures (FS) with or without comorbid epilepsy. We hypothesized that FS diagnosis during pregnancy is associated with a higher rate of pregnancy complications.

Background:

Convulsive events during pregnancy can be associated with injuries to the mother and fetus through falls and decreased placental perfusion, irrespective of if these convulsions are epileptic or functional. Unfortunately, pregnancy-related complications are common in patients with epilepsy, and the rate of delivery by cesarean section is elevated in community, but not academic medical centers. FS are diagnosed in ~30% of patients admitted for video-EEG monitoring, and 75% of patients with FS are women. FS also may occur during delivery, prompting delivery by cesarean section or misdiagnosis of eclampsia.

Design/Methods:

A retrospective chart review of over 800 charts of mothers delivering at a large academic medical center with the ICD-10 codes for pregnant plus either R56.9 (seizure) or F44.5 (conversion disorder with attacks or seizures) was performed. There were 25 mothers identified with the code for pregnant and F44.5 (68% were confirmed FS via video EEG monitoring). Eight mothers were identified as having both epilepsy and FS (32%). We evaluated the rate of pregnancy-related complications, pregnancy outcomes, co-morbid risk factors for FS and mode of delivery. 

Results:

Data was collected for 34 pregnancies in 25 patients (mean age 26.1 years). Pregnancy related complications and outcomes included: preeclampsia/eclampsia (20%), gestational diabetes (6.7%), gestational hypertension (16.7%), placental abruption (one), stillbirth (one, 3%), NICU admission (13.3%), small for gestational age (16.7%) and cesarean section delivery (61%).

Conclusions:

Pregnancy complications occurred at a high incidence in patients with FS. The elevated cesarean section rate mirrors the elevated rate seen in patients with epilepsy. Other complications may be associated with common medical comorbidities of FS.