Peripheral Neuropathy in Pregnancy

Changes in time structure of periodic leg movements during sleep in restless legs syndrome: Effects of sex and age

BACKGROUND

The objective of this study was to check the hypothesis that in women with restless legs syndrome (RLS) different changes occur in periodic leg movements during sleep (PLMS) during the post-menopausal period (using >50 years as a proxy) than in men of the same age.

METHODS

We recruited 36 untreated patients aged 18-50 years (19 men, median age 40 years, and 17 women, median age 37 years) while the remaining 67 were >50 years old (24 men, median age 66.6 years, and 43 women, median age 60.0 years). Leg movement activity during sleep was analyzed by means of an approach utilizing indexes especially suitable to assess leg movement periodicity.

RESULTS

No significant difference was seen between men in the two age groups; conversely, in women, a clear and significant increase in Periodicity Index was observed in the older group, along with a decrease in isolated leg movements. In women, a clear age-related enhancement of PLMS was found in the intermovement interval graphs, especially in the 16-22 s range, which was more evident than that observed in men. The results remained unchanged also when they were replicated by selecting only subjects aged 18-45 years vs. those aged >55 years.

CONCLUSIONS

Our findings indicate that assessing PLMS in women after menopause is clinically relevant because they are probably connected with the hormonal fluctuations of this period of life. Translationally, identifying and addressing PLMS in post-menopausal women is crucial for optimizing their sleep health and addressing potential health risks associated with sleep disturbances.

Incidence of Peripheral Nerve Decompression Surgery During Pregnancy and the First Year After Delivery in Finland From 1999 to 2017: A Retrospective Register-Based Cohort Study

PURPOSE

We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017.

METHODS

Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15-49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population.

RESULTS

In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4-0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8-3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9-1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3-1.9).

CONCLUSIONS

Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Postpartum peripheral nerve disorders are an uncommon obstetrical complication, with most cases resulting from intrinsic obstetric palsies. We present the case of a full-term nulliparous pregnant 33-year-old woman with a vacuum-assisted vaginal delivery due to a prolonged second stage of labour and occipitoposterior position of the fetal head. For analgesia, a combined spinal-epidural technique was used. Four hours after delivery, the patient experienced a painless asymmetric motor deficit and hypoesthesia in the lower limbs, followed by sphincter disturbance. Emergent MRI was unremarkable. Electromyography showed signs of a bilateral lumbosacral radiculopathy. The patient experienced a gradual recovery over the following 2 months. Although a definitive aetiological diagnosis could not be confirmed, a lumbosacral polyradiculopathy due to intrinsic obstetric complication was considered. The patient presented several risk factors known to be associated with intrinsic obstetric palsies. Obstetricians and anaesthesiologists have an important role in preventing and diagnosing postpartum peripheral nerve disorders.

Neuropathy and pregnancy: An overview

Peripheral nerve injuries are rare in pregnant women. Nevertheless, physiological changes linked to pregnancy may induce nerve lesion. In this review we propose to focus on peripheral nerve disorders the most frequently encountered in pregnant patients. Focal neuropathy or polyneuropathy may appear during pregnancy or at delivery. In other cases, pre-existing neuropathies may deteriorate during pregnancy. In addition to clinical description, we summarised management proposed in the literature.

Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life

Objectives

To investigate the prevalence of neuropathic pain in pregnant women and to state its influence on the functional status and health-related quality of life (HRQoL) in terms of physical, social, and emotional functioning.

Methods

A total of 90 pregnant women with lumbopelvic pain (LPP) and non-pregnant and healthy controls were included. The presence of neuropathic pain was determined using the Leeds assessment of neuropathic symptoms and signs (LANNS) questionnaire. The HRQoL was assessed using the Nottingham Health Profile (NHP), and the functional status was evaluated using the Oswestry Disability Index (ODI). The severity of pain was measured using a visual analog scale.

Results

The LANNS score was ≥12 in 34 pregnant women (37.8%). The prevalence of neuropathic pain was higher in pregnant women with LPP (odds ratio=6.22; 95% confidence interval=2.68-14.44) (p<0.001) than in controls. The LANNS score was found to be correlated with the physical mobility subgroup in the NHP at high levels (p=0.002, r=0.32) and with the ODI and pain subgroup in the NHP at moderate levels (p=0.013, r=0.26 and p=0.038, r=0.22, respectively).

Conclusion

The present study is the first to demonstrate that neuropathic pain is associated with pregnancy-related LPP and strongly correlated with functional impairment and deterioration in the HRQoL. A better understanding of neuropathic pain mechanisms in pregnancy-related LPP will help us find more effective treatment strategies.

Neurology of Pregnancy: A Case-Oriented Review

The anatomic and physiologic changes that occur during pregnancy are unique. A neurologist needs to be aware of normal pregnancy-induced physiologic changes in the cardiovascular, renal, hematologic, and autoimmune systems, and the local anatomic changes, which include alteration of body habitus and pelvic ligaments. These changes are clearly advantageous, but in certain circumstances may predispose to pathology. In addition, pregnancy effects treatment of chronic neurologic conditions as regards medication safety and metabolism. This case-oriented review discusses the important aspects of pregnancy physiology and an approach to treatment of common disorders encountered during pregnancy including stroke, multiple sclerosis, epilepsy, and compression neuropathies.

Peripheral neuropathies in pregnancy

PURPOSE OF REVIEW

This article provides an overview of the most common peripheral neuropathic disorders in pregnancy with a focus on clinical recognition, diagnosis, and treatment.

RECENT FINDINGS

The literature on this topic consists primarily of case reports, case series, and retrospective reviews. Recent work, particularly in carpal tunnel syndrome, brachial neuritis, and inherited neuropathies in pregnancy, has added to our knowledge of this field. Awareness of diabetic polyneuropathy with associated autonomic dysfunction in pregnancy has grown as the incidence of diabetes mellitus increases in women of childbearing age.

SUMMARY

Women may develop mononeuropathy, plexopathy, radiculopathy, or polyneuropathy during pregnancy or postpartum. Pregnancy often influences consideration of etiology, treatment, and prognosis. In women of childbearing age with known acquired or genetic neuromuscular disorders, pregnancy should be anticipated and appropriate counseling provided. An interdisciplinary approach with other medical specialties is often necessary.