Abstracts

Fetal distress has been reported with partial and generalized epileptic seizures, and nonepileptic seizures have been associated with autonomic dysfunction. However, the consequences of nonepileptic seizures on the fetus have not been well described. We evaluated a 20 year old right-handed Caucasian woman in the 28th week of pregnancy with a one-year history of possible seizures. Video/EEG monitoring was perfomed to make a definitive diagnosis of the clincal events, and continuous fetal heart rate monitoring was obtained to determine fetal distress. A typical event was recorded on video/EEG and continuous fetal heart tone monitoring. The event consisted of head bobbing, irregular truncal twitching with closed eyes that progressed to pelvic thrusting. Lorazepam 4 mg was emergently given. Upon review of the EEG, no electrographic correlate was found, and alpha rhythm was seen when the EEG was not obscured by myogenic artifact. The fetal heart rate by determined ultrasound was initially in the 140s, but fell to the 60s during this event. The patient[apos]s monitoring was discontinued and she was taken to emergent Caesarian section. In the operating room, the irregular motor activity stopped and fetal heart tone returned to the 140s. She was brought back to the labor and delivery floor for continued observation. Review of the video/EEG by a board-certified electroencephalograper supported the diagnosis on non-epileptic psychogenic seizures. The fetal heart monitoring and simultaneuous video/EEG will be presented as supportive evidence. Nonepileptic psychogenic seizures are often presumed to have minimal physiological effects, but associated autonomic dysfunction may have adverse consequences for some patients. Our observations support the potential for nonepileptic seizures to cause significant fetal distress during late pregnancy. Further research and vigilant clinical management may be indicated for pregnancy in woman with nonepileptic psychogenic seizures.