الفهرس Only 14 pages are availabe for public view
 |  | from | 198 |  |  |
| | | from | 198 | | |
Abstract
A
ny neurological disorder can occur during pregnancy it can present for the first time during pregnancy, only appears during pregnancy or it already existed before conception. Either way it requires special treatment that has to be a collaborate work of both the patient’s obstetrician and her neurologist so as to optimize medical management and minimize any risk on the mother or her foetus.
Freedom from seizures is the ultimate goal in treatment of patients with epilepsy and managing epilepsy during pregnancy should be a balance between the risks of uncontrolled seizures versus the probable teratogenic effect of AED. This can be achieved by using the appropriate AED for the woman’s seizure disorder as monotherapy in the lowest effective dosage throughout pregnancy which is preferably adjusted before conception.
One of the most common causes of maternal morbidity and mortality is preeclampsia and Eclampsia. Preeclampsia is defined as triad of edema, proteinuria, and hypertension after 20 weeks’ gestation and Eclampsia is diagnosed if seizures occur with the previous triad. Cerebral lesions occur due to loss of autoregulation of cerebral blood vessels and diffuse endothelial dysfunction. This condition is mainly treated using parentral magnesium sulphate.
Pregnant women have a three to thirteen-fold increase in their risk of developing a stroke (ischemic or hemorrhagic) than non-pregnant women, mainly due to complications of pregnancy such as preeclampsia, eclampsia and hyper-emesis gravidarum. Also hormonal changes during pregnancy and puerperium increase the risk of cerebral venous thrombosis. The use of asprin during pregnancy increases risk of teratoginicity. Thrombolytics is considered by some authors to be contraindicated during pregnancy. If anticoagulation is required during pregnancy, heparin is preferred as it does not cross the placenta whereas warfarin does.
Multiple sclerosis (MS) is the most common chronic disabling neurological disease affecting young women. Treatment of MS during pregnancy must consider the impact on the foetus. Rate of relapses decreases during pregnancy yet significantly increases in the first three months post-partum. MS does not seem to have an influence on pregnancy, delivery or child’s health. Most drugs used for the treatment of MS can be used during pregnancy except methotrexate and cyclophosphamide. Due to the progressive course of the disease, women with MS should be advised to start and complete their families as soon as possible.
Migraine markedly improves during pregnancy and physician may consider the discontinuation of all migraine medications because of possible fetal malformation. Sumatriptan and beta blockers can be used with the least effective dose if the migraine persists and prophylaxis is needed. It is preferably treated with adequate rest and acetaminophen. Ergotamine is contraindicated.
Neuromuscular disease in pregnancy includes: carpal tunnel syndrome, Bell’s palsy (which is three to four times more common during pregnancy and the puerperium.), lumbosacral radiculopathy, meralgia parasthetica and other compression neuropathies. Demyelinating polyneuropathies, inflammatory muscle disease, chronic autoimmune diseases such as myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy and inherited nerve and muscle disease may pre-exist before pregnancy. Women with these disorders are able to deliver healthy infants; however, they require special treatment during pregnancy and care during delivery to avoid any possible complications.
Chorea occurring during pregnancy (chorea gravidarum) was mostly associated with rheumatic heart disease. It is now more commonly associated with antiphospholipid antibody syndrome and systemic lopus erythromatosis and is treated with low doses of haloperidol.
Symptoms related to sleep are more common in pregnant women than in non pregnant women. Pregnant women are most likely to snore and to have insomnia and daytime sleepiness. A variety of factors may contribute to this increase in symptoms, including weight gain, hormonal changes, nutritional stress, and nocturnal discomfort. Restless leg syndrome is a common disorder during pregnancy and one of the suggested aetiology is iron deficiency so iron supplementation is used for treatment. It has a favorable prognosis and often resolves after labour.
Any brain tumor can occur during pregnancy yet there is no definite study to prove whether pregnancy may increase morbidity or mortality in women with brain tumors. Some tumors grow more rapidly during pregnancy and idiopathic intracranial hypertension worsens with pregnancy. Corticosteroids are used to decrease symptoms yet sometimes surgery is needed to remove tumors compressing vital areas of the brain.
Comprehensive care of women who have neurological diseases with pregnancy ideally results in the most preferable outcome for both mother and foetus.