the patient was a 27-year - old primigravida who was diagnosed as epilepsy with cortical dysplasia 21 years before . her previous seizures were reasonably controlled by topiramate , carbamazepine , and pregabalin . at 23 weeks of pregnancy , her seizure frequency progressively increased . she came to the er in a confused mental state with intermittent convulsive movements in her arm that lasted for a few hours . on neurological examination , her mental status was stuporous , but there were no focal neurological deficits . initial electroencephalography ( eeg ) revealed very frequent and sharp medium- to high - voltage waves in the left fronto - centro - parietal area that built up repetitive high - voltage , generalized sharp , and wave complexes for 10 to 20 sec , which suggested se . these ictal rhythms were correlated with initial head and eyeball deviation that was secondary to generalized tonic - clonic seizures . between the seizures , consciousness was not regained . except for the pregnancy , she was admitted to the icu , and she was managed with a continuous infusion of intravenous midazolam under continuous eeg ( c - eeg ) monitoring . on the eeg , very frequent sharp waves with repetitive ictal rhythms appeared in the left centro - parieto - occipital area . midazolam was titrated up to 5.5 mg / kg / h , but the ictal rhythms with clinical seizures were not successfully controlled . on the fifth hospital day ( hd 5 ) , midazolam was dosed up to 17 mg / kg / h , her blood pressure was reduced to 80/50 , but the repeated seizures were not controlled . midazolam was tapered slowly from hd 10 to hd 16 , and then her mental state and eeg findings were improved except for an occasional brief seizure . on hd 32 , phenytoin , phenobarbital , and pentobarbital were sequentially loaded for a few days with intervals , but se continued . on hd 43 , at 29 weeks of pregnancy , a cesarean section was performed . the eeg performed the day after parturition showed only intermittent median voltage sharp waves in the left centro - parietal area . her mentality gradually improved , and accordingly , previous anti - se drugs were gradually tapered out . she was discharged with an alert mental status , and the discharge medications were topiramate ( 300 mg ) , pregabalin ( 450 mg ) , levetiracetam ( 3,000 mg ) , and phenobarbital ( 180 mg ) . her baby was raised in the newborn section because of premature and low birth weight . se during pregnancy is a relatively rare condition . according to a recent review of many studies of women with epilepsy , the rate of seizure increase during pregnancy ranged from 14% to 32% . the frequency of se during pregnancy was 0% to 1.3% , which was less than the annual frequency of 1.6% for se reported in a large series of patients with epilepsy . these studies were not case - controlled , and so there is insufficient evidence to support an increased risk of se and seizure frequency with pregnancy . however , we can confirm that the seizure threshold can be influenced by many factors during pregnancy , such as poor compliance and hormonal , pharmacokinetic , and emotional changes . therefore , se in this state is not always predictable and preventable . in our patient , the se was not controllable by any antiepileptic drugs , including midazolam or pentobarbital , but it spontaneously ceased after parturition . she did not have a vitamin deficiency , metabolic abnormality , or any other medical problems . we considered that there might have been a different mechanism underlying the continual ictal activity and pharmacoresistancy , such as eclampsia . the precise etiopathogenesis of convulsions in eclampsia remains obscure , but recent studies have suggested that a different mechanism other than hypertension or cerebral edema can cause seizures in eclampsia . neurotransmitters , such as neurokinin b and the proin - flammatory cytokines , tnf - a , il-6 , and il-10 , can excite nmda glutamatergic receptors , and they play an important role in increasing neuronal excitability . they were reported to be increased in patients with eclampsia . increased tissue plasminogen activator ( t - pa ) , which activates excitatory receptors , may enhance epileptogenesis . nevertheless , our patient showed no signs of eclampsia or hormonal and neuromodulatory changes during pregnancy that might have contributed to the development of rse . unfortunately , the patient s gestational age was too early for labor in our case , and so we had to wait , even though the best way to control eclampsia is with parturition as soon as possible . thus , pregnancy in women with epilepsy needs to be well planned with stratified levels of management . in addition , parturition may be beneficial and the best treatment option in pregnant patients with rse .
status epilepticus ( se ) in pregnancy is very rare , and there are only a few case reports of refractory se ( rse ) during pregnancy . 
 the patient was a 27-year - old primigravida woman with a 21-year history of seizures from cortical dysplasia . at 23 weeks of pregnancy , 
 the patient s seizure frequency progressively increased , and the patient came to the er in a confused mental state and with intermittent convulsive movements of her left arm . 
 electroencephalography ( eeg ) revealed repeated seizures . 
 she was admitted to the icu , and continuous eeg monitoring was done . 
 treatment was immediately started with various anti - se medications , but her se was not controlled . 
 a cesarean section was done , and se spontaneously stopped two weeks after the parturition . 
 parturition may be beneficial and the best treatment option in pregnant patients with rse .