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Smilowska K, Mehanna R, Fleisher JE, Alcalay RN, Kumar KR, Marras C, Oosterbaan AM, Post B, Ross OA, Pimentel Piemonte ME, Fraix V, Moro E, King Tan E, Savica R. Unmet Need in Early-Onset Parkinson's Disease: Deep Brain Stimulation and Pregnancy. JOURNAL OF PARKINSON'S DISEASE 2024:JPD240088. [PMID: 38995803 DOI: 10.3233/jpd-240088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Pregnancy in women with early-onset Parkinson's disease (PD) is likely to have a higher frequency given the trend toward increasing maternal age, thus resulting in a greater overlap time between childbearing age and PD risk. Deep brain stimulation (DBS) therapy is nowadays offered to PD patients at earlier stage of the disease, when women can still be pre-menopausal. However, few data are available about DBS safety during pregnancy. From a review of the available literature, only one article was published on this topic so far. Therefore, we have developed a clinical consensus on the safety of DBS during pregnancy in PD patients.
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Affiliation(s)
- Katarzyna Smilowska
- Department of Neurology, 5th Regional Hospital in Sosnowiec, Poland
- Silesian Center of Neurology, Katowice, Poland
| | - Raja Mehanna
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kishore Raj Kumar
- Molecular Medicine Laboratory and Department of Neurology, Concord Repatriation General Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease, University Health Network, University of Toronto, Toronto, Canada
| | - Annelien M Oosterbaan
- Department of Neurology and Expertise Center for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology and Expertise Center for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Valerie Fraix
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble, France
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble, France
| | - Eng King Tan
- National Neuroscience Institute, Singapore, Singapore
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, USA
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Abusrair A, Bruno V. Pregnancy in Generalized Dystonia: A Case of DBS Discontinuation. Can J Neurol Sci 2024; 51:312-313. [PMID: 36503587 DOI: 10.1017/cjn.2022.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ali Abusrair
- Department of Clinical Neurosciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronica Bruno
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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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] [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
IntroductionDeep 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.MethodsA 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.ResultsThe 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.ConclusionThe 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
- *Correspondence: Joshua K. Wong,
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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, E. Freire, Gómez Esteban J, Legarda I, López Manzanares L, López Valdés E, Martínez-Torres I, Mata M, Pareés I, Pascual-Sedano B, Mir P, Martínez Castrillo J. Management of Parkinson’s disease and other movement disorders in women of childbearing age: Part 1. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Management of Parkinson’s disease and other movement disorders in women of childbearing age: Part 2. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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 J, Legarda I, López Manzanares L, López Valdés E, Martínez-Torres I, Mata M, Pareés I, Pascual-Sedano B, Mir P, Martínez Castrillo J. Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: Parte 1. Neurologia 2021; 36:149-158. [DOI: 10.1016/j.nrl.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
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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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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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Young C, Phillips R, Ebenezer L, Zutt R, Peall KJ. Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input. Mov Disord Clin Pract 2020; 7:419-430. [PMID: 32373659 PMCID: PMC7197310 DOI: 10.1002/mdc3.12925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/29/2020] [Accepted: 02/08/2020] [Indexed: 11/09/2022] Open
Abstract
Background There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase. Objective To evaluate the evidence for the treatment of PD during pregnancy and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting. Methods This involved (1) a literature review of available evidence for the use of oral medical therapy for the management of PD during pregnancy and (2) an anonymized survey of patients and clinical teams relating to previous clinical experiences. Results A literature review identified 31 publications (148 pregnancies, 49 PD, 2 parkinsonism, 21 dopa-responsive dystonia, 32 restless leg syndrome, 1 schizophrenia, and 43 unknown indication) detailing treatment with levodopa, and 12 publications with dopamine agonists. Adverse outcomes included seizures and congenital malformations. Survey participation included patients (n = 7), neurologists (n = 35), PD nurse specialists (n = 50), obstetricians (n = 15), and midwives (n = 20) and identified a further 34 cases of pregnancy in women with PD. Common themes for suggested management included optimization of motor symptoms, preference for levodopa monotherapy, and normal delivery unless indicated by obstetric causes. Conclusions This study demonstrates the paucity of evidence for decision-making in the medical management of PD during pregnancy. Collaboration is needed to develop a prospective registry, with longitudinal maternal and child health outcome measures to facilitate consensus management guidelines.
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Affiliation(s)
- Caitlin Young
- Cardiff University School of Medicine, Cardiff University Cardiff United Kingdom
| | - Rhiannon Phillips
- Division of Population Medicine, School of Medicine Cardiff University Cardiff United Kingdom
| | - Louise Ebenezer
- Princess of Wales Hospital Abertawe Bro Morgannwg University Health Board Bridgend Wales United Kingdom
| | - Rodi Zutt
- Department of Neurology Haga Teaching Hospital The Hague The Netherlands
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University Cardiff United Kingdom
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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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