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Yang K, Mistry PD, Richeimer SH. Intrathecal baclofen pump in pregnancy: case report, literature review, and management considerations. Reg Anesth Pain Med 2024:rapm-2024-105569. [PMID: 38772633 DOI: 10.1136/rapm-2024-105569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Baclofen, a gamma-aminobutyric acid receptor type B agonist in the central nervous system, is the first-line medication among central nervous system modulating agents for the treatment of neurogenic muscle spasticity. While baclofen is most often administered enterally, patients with severe spasticity may be candidates for baclofen delivered by intrathecal pump. Currently, there are only nine studies reporting on the use of intrathecal baclofen (ITB) during pregnancy and childbirth. CASE PRESENTATION We described a female patient with a history of childhood idiopathic spasticity of the bilateral lower extremities that was controlled by ITB pump who became pregnant in her late third decade of life and delivered a healthy infant. The patient required multiple increases of her baclofen course over the course of her pregnancy. DISCUSSION Our case, alongside the existing literature on ITB during pregnancy, suggests that ITB therapy in pregnancy poses a low risk of teratogenicity and infant withdrawal seizures; however, larger, controlled studies are necessary to make those conclusions with confidence. Healthcare providers caring for pregnant ITB patients should be cognizant of the potential for such patients to require increased doses of ITB during pregnancy to achieve adequate symptom control.
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Affiliation(s)
- Kevin Yang
- USC Keck School of Medicine, Los Angeles, California, USA
| | - Porus D Mistry
- USC Keck School of Medicine, Los Angeles, California, USA
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García-Ramos R, Santos-García D, Alonso-Cánovas A, Álvarez-Sauco M, Ares B, Ávila A, Caballol N, Carrillo F, Escamilla Sevilla F, Freire E, Gómez Esteban JC, Legarda I, López Manzanares L, López Valdés E, Martínez-Torres I, Mata M, Pareés I, Pascual-Sedano B, Martínez Castrillo JC, Mir P. Management of Parkinson's disease and other movement disorders in women of childbearing age: Part 2. Neurologia 2020; 36:159-168. [PMID: 32980194 DOI: 10.1016/j.nrl.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.
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Affiliation(s)
- R García-Ramos
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, Madrid, España.
| | - D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | | | - M Álvarez-Sauco
- Hospital General Universitario de Elche, Elche, Alicante, España
| | - B Ares
- Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - A Ávila
- Consorci Sanitari Integral, Hospital General de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España; Consorci Sanitari Integral, Hospital Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - N Caballol
- Consorci Sanitari Integral, Hospital Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - F Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - F Escamilla Sevilla
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario Virgen de las Nieves, Granada, España
| | - E Freire
- Hospital General Universitario de Elche, Elche, Alicante, España; Hospital IMED Elche, Elche, Alicante, España
| | | | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | | | - E López Valdés
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, Madrid, España
| | | | - M Mata
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - I Pareés
- Hospital Universitario Ramón y Cajal, Madrid, España; Hospital Rúber Internacional, Madrid, España
| | - B Pascual-Sedano
- Estudios de Ciencias de la Salud, Hospital Santa Creu i Sant Pau, Barcelona, España; Universitat Oberta de Catalunya (UOC), Barcelona, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | | | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Hospital Rúber Internacional, Madrid, España
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