A continuing controversy: magnesium sulfate in the treatment of eclamptic seizures
P. W. Kaplan, R. P. Lesser, R. S. Fisher, J. T. Repke and D. F. Hanley
Department of Neurology, Francis Scott Key Medical Center, Baltimore, MD 21224.
It would appear from the above that Pritchard agrees with the use of some
agents other than magnesium sulfate that have known anticonvulsant
properties. We believe that the subject at issue is whether magnesium
sulfate should be used in treating the seizures of eclampsia. In our
"Controversies" article, we do not address the issue of whether magnesium
sulfate modifies pathophysiological factors leading to preeclampsia, but
restrict ourselves to the treatment of the seizure per se, once seizures
supervene, and the avoidance of their recurrence. The pathophysiological
mechanisms and optimal treatment of preeclampsia and of eclampsia
(excepting seizures) remain to be determined, as does the use of magnesium
sulfate in this condition. Eclamptic seizures are clinically and
electroencephalographically indistinguishable from generalized tonic-clonic
seizures. Whether seizures arise in or out of the setting of preeclampsia,
they should be treated as are other seizures, with known anticonvulsants.
Controlled clinical trials are needed to address the effectiveness of
alternative antiseizure regimens.
