Abstracts

RATIONALE: Status epilepticus in pregnancy can be life-threatening to both mother and fetus. We present a case in which insufficient vitamin B6 levels did cause status. METHODS:_This 30-year old female patient suffered from vitamin B6-dependent seizures since early childhood. With oral substitution of 100 mg Vit. B6/day she had remained seizure-free for 24 years. In the 14th gestational week, a generalized tonic-clonic seizure occurred which developed into a status epilepticus of complex partial and generalized tonic-clonic seizures. Status persisted despite i.v. treatment with diazapam and phenytoin (serum level 30.4 /ml). She was thus transferred to the ICU for treatment with phenobarbitone at dosages sufficient to induce a burst-suppression pattern. A rise in body temperature, leucocytosis, and elevated CRP initially suggested an underlying infection. This could, however, not be confirmed. Vitamin B6 levels were found to be subnormal. RESULTS:_After i.v. and later oral substitution of vitamin B6, EEG normalized and remained normal also with tapering of anticonvulsants. The patient regained consciousness and remained seizure free for the rest of her pregnancy. In the same patient another series of tonic-clonic seizures later developed during a respiratory infection. Again, application of vitamin B6 but not anticonvulsive treatment stopped the series. In this case, Vit. B6 levels were in the normal range, but on an individual basis too low to prevent seizures. CONCLUSIONS:_This case report suggests that at least in patients prone to vitamin-B6 dependent seizures, increased vitamin B6-turnover during pregnancy and during infections can induce seizures and status epilepticus. Monitoring of vitamin B6-levels and intravenous vitamin B6 substitution seems to be advisable in these patients.