Seizure for the first time during pregnancy can have multiple differentials listed in Table 13.1. Management of a pregnant women presenting with epileptic fit involves a detailed history, physical examination, appropriate investigation and prompt treatment for seizure control. History taking is the most important tool in diagnosing seizure and should focus on symptoms during and after the seizure episode. Other associated factors to be taken into account include previous history of seizure, brain tumour or trauma, stroke, precipitating events (alcohol or medications) and past obstetrical history. Symptoms during seizure are usually described by an eyewitness and include presence of aura, changes in respiration, altered consciousness, bowel/bladder dysfunction and generalised or focal tonic-clonic movements. Seizure episode is usually followed by amnesia, weakness, headache, body aches and drowsiness. Physical examination includes pulse and blood pressure measurement and thorough neurological examination including optic fundi. Ancillary investigations include electroencephalography (EEG), imaging of the brain and laboratory studies. EEG is safe during pregnancy and is the recommended initial neurodiagnostic investigation. It is found to be normal in 50% of cases, and abnormality indicates risk of seizure recurrence and helps guide therapy. The American Academy of Neurology and the American Society of Epilepsy recommend computed tomography (CT) and magnetic resonance imaging (MRI) of the brain as initial neurodiagnostic tests to help determine underlying aetiology [2]. CT of the brain delivers <1 rad to foetus, and exposure below 5 rad is not associated with increased risk of foetal anomalies or pregnancy loss [3]. MRI has no radiation exposure and is more sensitive than CT but is costly and not readily available. Laboratory studies include full blood count, serum urea and electrolytes, blood sugars and urine protein estimation and toxicology screen.

The International Classification of Epileptic Seizures categorises seizures into two broad groups (International League against Epilepsy [4]):