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Baláž M, Búřil J, Kunst J, Hrabovský D, Hajda Š, Chrastina J. Deep Brain Stimulation during Pregnancy and Delivery: Review of Current Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:275-280. [PMID: 36261059 DOI: 10.1055/s-0042-1753549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Deep brain stimulation (DBS) is an established method in the treatment of not only Parkinson's disease motor complications but also dystonia and tremor, and there are data supporting the efficacy of DBS in epilepsy and some psychiatric problems. The alleviation of the neurologic problems may enable females of childbearing age to consider pregnancy because of being able to take care of their child. The aim of the study is to provide a review of the data available on the effect of DBS on the course of pregnancy and delivery in patients suffering from diseases amenable for DBS treatment (Parkinson's disease, dystonia, obsessive compulsive disorder, Tourette's syndrome, epilepsy). Although data available in the literature on pregnancy and childbirth in patients with an implanted active DBS system are limited to small case series and case reports, the number of younger patients implanted with DBS systems will potentially require more attention beyond specialized DBS centers. In emergency deliveries, general obstetricians and neurosurgeons should be provided with a protocol to prevent injuries to the implanted system with potentially devastating consequences for the patient.
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Affiliation(s)
- Marek Baláž
- 1st Department of Neurology, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Búřil
- 1st Department of Neurology, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jonáš Kunst
- 1st Department of Neurology, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Dušan Hrabovský
- Department of Neurosurgery, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Šimon Hajda
- Universitätsklinik der Paracelsus Medizinischen Privatuniversität Klinikum Nürnberg - Klinik für Frauenheilkunde und Geburtshilfe, Schwerpunkt Geburtshilfe, Nürnberg, Germany
| | - Jan Chrastina
- Department of Neurosurgery, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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King C, Parker TM, Roussos-Ross K, Ramirez-Zamora A, Smulian JC, Okun MS, Wong JK. Safety of deep brain stimulation in pregnancy: A comprehensive review. Front Hum Neurosci 2022; 16:997552. [PMID: 36248692 PMCID: PMC9557283 DOI: 10.3389/fnhum.2022.997552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy. Methods A literature review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment. Results The literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on "adequate contraception" or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons. Conclusion The data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients.
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Affiliation(s)
- Caroline King
- Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL, United States
| | - T. Maxwell Parker
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kay Roussos-Ross
- Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL, United States
- Center for Research in Perinatal Outcomes, University of Florida College of Medicine, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, United States
| | - John C. Smulian
- Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL, United States
- Center for Research in Perinatal Outcomes, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, United States
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Kadiroğulları P, Ozturk G. Management of pregnancy and childbirth in a cervical dystonia patient with an implanted deep brain stimulation system: A case report. Ann Indian Acad Neurol 2021; 25:121-123. [PMID: 35342240 PMCID: PMC8954303 DOI: 10.4103/aian.aian_151_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) can lead to psychosocial and functional improvement in medically refractory cervical, segmental, or generalized moderate to severe dystonia. After treatment with DBS in women with dystonia, pregnancy can be planned. However, in the literature, there are no standardized clinical guidelines for the management of movement disorder treated with DBS during pregnancy. Herein, we report a 24-year-old female patient with cervical dystonia (CD) who have an implanted bilateral globus pallidus interna (GPi)-DBS. The patient got pregnant during the 5-year follow-up period after DBS surgery and then delivered a healthy baby via cesarean section under general anesthesia. A patient with CD who have a DBS system with a rechargeable battery could be managed safely during pregnancy and childbirth.
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Abstract
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
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Griffiths J, Teddy P. Neuromodulation and obstetric anaesthesia. Int J Obstet Anesth 2017; 30:1-4. [DOI: 10.1016/j.ijoa.2017.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Park HR, Lee JM, Park H, Shin CW, Kim HJ, Park HP, Kim DG, Jeon BS, Paek SH. Pregnancy and Delivery in a Generalized Dystonia Patient Treated with Internal Globus Pallidal Deep Brain Stimulation: a Case Report. J Korean Med Sci 2017; 32:155-159. [PMID: 27914146 PMCID: PMC5143289 DOI: 10.3346/jkms.2017.32.1.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/02/2016] [Indexed: 11/22/2022] Open
Abstract
Internal globus pallidus (GPi) deep brain stimulation (DBS) has been widely accepted as an effective treatment modality of medically refractory dystonia. However, there have been few studies regarding the safety issue of pregnancy and childbirth related with DBS. This report describes a female patient who was pregnant and delivered a baby after GPi DBS surgery. A 33-year-old female patient with acquired generalized dystonia underwent bilateral GPi DBS implantation. She obtained considerable improvement in both movement and disability after DBS implantation. Four years later, she was pregnant and the obstetricians consulted us about the safety of the delivery. At 38-weeks into pregnancy, a scheduled caesarian section was carried out under general anesthesia. After induction using thiopental and succinylcholine, intubation was done quickly, followed by DBS turn off. For hemostasis, only bipolar electrocautery was used. Before awakening from the anesthesia, DBS was turned on as the same parameters previously adjusted. After delivery, she could feed her baby by herself, because the dystonia of left upper extremity and hand was improved. Until now, she has been showing continual improvement and being good at housework, carrying for children, with no trouble in daily life. This observation indicates that the patients who underwent DBS could safely be pregnant and deliver a baby.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyeyoung Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Chae Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Han Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hee Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Beom Seok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
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Ziman N, Coleman RR, Starr PA, Volz M, Marks WJ, Walker HC, Guthrie SL, Ostrem JL. Pregnancy in a Series of Dystonia Patients Treated with Deep Brain Stimulation: Outcomes and Management Recommendations. Stereotact Funct Neurosurg 2016; 94:60-5. [PMID: 26977859 DOI: 10.1159/000444266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medically refractory dystonia affects children and young adults, and deep brain stimulation (DBS) can allow some patients to regain functional independence. Women with dystonia treated with DBS may wish to conceive a child, but there is limited published information on pregnancy and DBS. OBJECTIVE To describe a series of dystonia patients treated with DBS who later became pregnant and provide guidelines for women treated with DBS considering conception. METHODS We reviewed all dystonia DBS cases implanted at the University of California, San Francisco, and University of Alabama at Birmingham from 1998 to 2015 and identified patients who became pregnant. Patient records were reviewed and structured interviews were conducted. RESULTS Six dystonia patients were identified [1 currently pregnant and 7 live births (including 1 twin pair)]. Patients (n = 5) with pre- and postoperative BFMDRS (Burke-Fahn-Marsden Dystonia Rating Scale) scores improved by 65.9% after DBS. All pregnancies and deliveries were uncomplicated (the delivery mode was not influenced by the presence of DBS), except for 1 child, who was born premature at 35 weeks' gestation. Stimulation remained on (n = 3) or off (n = 4) during deliveries. DBS neurostimulators did not hinder breastfeeding. CONCLUSIONS In this small sample, pregnancy, delivery, and breastfeeding were safe in dystonia patients treated with DBS. The presence of DBS should not be a contraindication to pregnancy.
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Affiliation(s)
- Nathan Ziman
- Department of Neurology, University of California, San Francisco, Movement Disorder and Neuromodulation Center, San Francisco, Calif., USA
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Scelzo E, Mehrkens JH, Bötzel K, Krack P, Mendes A, Chabardès S, Polosan M, Seigneuret E, Moro E, Fraix V. Deep Brain Stimulation during Pregnancy and Delivery: Experience from a Series of "DBS Babies". Front Neurol 2015; 6:191. [PMID: 26388833 PMCID: PMC4556026 DOI: 10.3389/fneur.2015.00191] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/17/2015] [Indexed: 01/11/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is widely used to improve quality of life in movement disorders (MD) and psychiatric diseases. Even though the ability to have children has a big impact on patients’ life, only a few studies describe the role of DBS in pregnancy. Objective To describe risks and management of women treated by DBS for disabling MD or psychiatric diseases during pregnancy and delivery. Methods We report a retrospective case series of women, followed in two DBS centers, who became pregnant and went on to give birth to a child while suffering from disabling MD or psychiatric diseases [Parkinson’s disease, dystonia, Tourette’s syndrome (TS), Obsessive Compulsive Disorder (OCD)] treated by DBS. Clinical status, complications and management before, during, and after pregnancy are reported. Two illustrative cases are described in greater detail. Results DBS improved motor and behavioral disorders in all patients and allowed reduction in, or even total interruption of disease-specific medication during pregnancy. With the exception of the spontaneous early abortion of one fetus in a twin pregnancy, all pregnancies were uneventful in terms of obstetric and pediatric management. DBS parameters were adjusted in five patients in order to limit clinical worsening during pregnancy. Implanted material limited breast-feeding in one patient because of local pain at submammal stimulator site and led to local discomfort related to stretching of the cable with increasing belly size in another patient whose stimulator was implanted in the abdominal wall. Conclusion Not only is it safe for young women with MD, TS and OCD who have a DBS-System implanted to become pregnant and give birth to a baby but DBS seems to be the key to becoming pregnant, having children, and thus greatly improves quality of life.
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Affiliation(s)
- Emma Scelzo
- Department of Neurology, Policlinico San Donato, Milan University , Milan , Italy ; Clinical Center for Neurotechnology, Neurostimulation and Movement Disorders, Fondazione IRCCS Ca' Granda - Ospedale Maggiore di Milano , Milan , Italy ; Department of Neurology, Grenoble University Hospital , Grenoble , France
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-University , Munich , Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-University , Munich , Germany
| | - Paul Krack
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
| | - Alexandre Mendes
- Department of Neurology, Porto University Hospital , Porto , Portugal
| | - Stéphan Chabardès
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neurosurgery, Grenoble University Hospital , Grenoble , France
| | - Mircea Polosan
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neuropsychiatry, Grenoble University Hospital , Grenoble , France
| | - Eric Seigneuret
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neurosurgery, Grenoble University Hospital , Grenoble , France
| | - Elena Moro
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
| | - Valerie Fraix
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
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Abstract
BACKGROUND Depression during pregnancy affects 5%-8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions. OBJECTIVE We review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed. METHODS A literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included. CONCLUSION The data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population.
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Affiliation(s)
- Deborah R Kim
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica L Snell
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Grace C Ewing
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John O’Reardon
- Department of Psychiatry, Rowan University, Rowan School of Medicine, Cherry Hill, NJ, USA
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Lefaucheur R, Derrey S, Borden A, Verspyck E, Tourrel F, Maltête D. Patient with perinatal brain injury dystonia treated by deep brain stimulation: Management during pregnancy. Rev Neurol (Paris) 2014; 171:90-1. [PMID: 25444172 DOI: 10.1016/j.neurol.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/12/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Affiliation(s)
- R Lefaucheur
- Department of Neurology, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - A Borden
- Department of Neurology, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - E Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Tourrel
- Department of anaesthesiology, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1079, Rouen Faculty of Medicine, faculté de médecine et pharmacie, 22, boulevard Gambetta, 76183 Rouen cedex, France
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Abstract
PURPOSE OF REVIEW This review discusses movement disorders that occur during pregnancy, the treatment of preexisting movement disorders, and the influence the pregnant state has on movement disorders symptoms, in order to guide clinicians in providing better counseling for female patients who are pregnant or considering pregnancy. RECENT FINDINGS Unique considerations for movement disorders during pregnancy include investigations and their safety during pregnancy and the impact of treatment on both the pregnant patient and her fetus. SUMMARY The most common movement disorders arising in pregnancy are restless leg syndrome and chorea gravidarum. Preexisting movement disorders in women who become pregnant may also be seen.
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Rabin ML, Stevens-Haas C, Havrilla E, Devi T, Kurlan R. Movement disorders in women: A review. Mov Disord 2013; 29:177-83. [DOI: 10.1002/mds.25723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 01/20/2023] Open
Affiliation(s)
- Marcie L. Rabin
- Atlantic Neuroscience Institute; Overlook Medical Center; Summit New Jersey
| | | | - Emilyrose Havrilla
- Atlantic Neuroscience Institute; Overlook Medical Center; Summit New Jersey
| | - Tanvi Devi
- Atlantic Neuroscience Institute; Overlook Medical Center; Summit New Jersey
| | - Roger Kurlan
- Atlantic Neuroscience Institute; Overlook Medical Center; Summit New Jersey
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Abstract
Neurostimulation as a treatment for epilepsy has been around for almost 20 years in the form of vagus nerve stimulation. Newer types of neurostimulation are being developed and stand on the brink of approval for use. The two newest therapies, not yet approved in the United States, are deep brain stimulation and the Responsive Neurostimulator System . In fact, in Europe, approval has already been given for deep brain stimulation and newer forms of vagus nerve stimulation. Efficacy is similar between these therapies, and side effects are moderate, so what will be the future? The challenge will be to learn how to use these therapies correctly and offer the right treatment for the right patient.
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Nageshwaran S, Nageshwaran S, Edwards MJ, Morcos M. Management of DYT1 dystonia throughout pregnancy. BMJ Case Rep 2011; 2011:bcr.05.2011.4214. [PMID: 22679185 DOI: 10.1136/bcr.05.2011.4214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old woman with generalised DYT1 dystonia, controlled with medication, presented at 9 weeks gestation with an unplanned pregnancy. A number of learning points were highlighted in management of the patient's dystonia alongside pregnancy including avoidance of excessive medication exposure to the fetus, while maintaining symptom control to a level acceptable and safe for the patient and prenatal diagnostic testing. In our case there was no overt ill effect to the newborn. This is a common worry among pregnant women with dystonia and as such the authors felt it important to report.
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Kranick SM, Mowry EM, Colcher A, Horn S, Golbe LI. Movement disorders and pregnancy: A review of the literature. Mov Disord 2010; 25:665-71. [DOI: 10.1002/mds.23071] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis NM. Surgery for movement disorders. Neurosurgery 2008; 62 Suppl 2:809-38; discussion 838-9. [PMID: 18596424 DOI: 10.1227/01.neu.0000316285.52865.53] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Movement disorders, such as Parkinson's disease, tremor, and dystonia, are among the most common neurological conditions and affect millions of patients. Although medications are the mainstay of therapy for movement disorders, neurosurgery has played an important role in their management for the past 50 years. Surgery is now a viable and safe option for patients with medically intractable Parkinson's disease, essential tremor, and dystonia. In this article, we provide a review of the history, neurocircuitry, indication, technical aspects, outcomes, complications, and emerging neurosurgical approaches for the treatment of movement disorders.
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Affiliation(s)
- Ali R Rezai
- Center for Neurological Restoration, and Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio 44122, USA.
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