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Objetivos: determinar a freqüência de recorrência das crises convulsivas após tratamento com sulfato de magnésio, avaliando o tratamento adotado e o prognóstico materno. Casuística e Métodos: analisaram-se todos os casos de eclâmpsia atendidos no IMIP entre janeiro de 1995 e junho de 1998. Sulfato de magnésio e oxigenoterapia foram administrados para todas as pacientes, interrompendo-se a gravidez após estabilização do quadro clínico. Determinou-se a freqüência de complicações maternas de acordo com a presença ou não de recorrência da crise convulsiva, utilizando-se o teste chi² de associação, a um nível de significância de 5%. Resultados: doze pacientes apresentaram recorrência da eclâmpsia após sulfato de magnésio (10%), repetindo-se então metade da dose de ataque. Em 4 destas verificou-se nova recorrência, administrando-se então diazepam endovenoso. Depois do diazepam, uma paciente ainda teve crises repetidas, sendo então realizada infusão de fenitoína e, posteriormente, indução do coma barbitúrico (tionembutal). Essa paciente foi submetida a tomografia computadorizada, constatando-se hemorragia intracraniana. As complicações maternas foram significativamente mais freqüentes no grupo com recorrência: coma (16,7% versus 0,9%), acidose (50% versus 2,9%), edema agudo de pulmão (16,7% versus 2,9%), hemorragia cerebral (16,7% versus 0%) e insuficiência renal aguda (16,7% versus 1,9%). Ocorreram 3 casos de morte materna no grupo com recorrência (25%) e 2 no grupo sem recorrência (1,9%). Conclusões: a recorrência da crise convulsiva é pouco freqüente após uso do sulfato de magnésio (10%), porém associa-se a aumento da morbimortalidade materna, requerendo acompanhamento em UTI e realização de tomografia para exclusão de hemorragia cerebral. Purpose: to determine the frequency of recurrence of seizures after anticonvulsant therapy with magnesium sulfate and to evaluate treatment and maternal prognosis. Patients and Methods: a prospective cohort study was conducted, enrolling all cases of eclampsia managed at IMIP between January/1995 and June/1998. Magnesium sulfate and oxygen therapy were administered routinely and interruption of pregnancy was performed after maternal stabilization. The frequency of recurrence of seizures and its association with maternal complications were determined. chi² test for association was used at a 5% level of significance. Results: twelve cases presented recurrence of convulsions after magnesium sulfate (10%) and all received a repeated dose. In four of them convulsions persisted and they received intravenous diazepam. After diazepam, one patient still had seizures, with unsuccessful administration of phenytoin and therefore barbituric coma was induced (thionembutal). This patient had a CT-scan with evidence of intracerebral hemorrhage. Maternal complications were significantly more frequent in the group with recurrence: coma (16.7% versus 0.95), acidosis (50% versus 2.9%), pulmonary edema (16.7% versus 2.9%), cerebral hemorrhage (16.7% versus 0%) and acute renal failure (16.7% versus 1.9%). Three cases of maternal death occurred in patients with recurrence (25%) versus 2 cases in patients without recurrence (1.9%). Conclusions: rate of recurrence after anticonvulsant therapy with magnesium sulfate is low (10%) but it is associated with increased maternal morbidity and mortality. These cases must be managed in an intensive care unit and submitted to routine CT-scan because cerebral hemorrhage can be the cause of recurrence

Recorrência da Crise Convulsiva após Terapia Anticonvulsivante com Sulfato de Magnésio em Pacientes com Eclâmpsia