Pregnancy in a Series of Dystonia Patients Treated with Deep Brain Stimulation: Outcomes and Management Recommendations

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 postoperativeBFMDRS (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.

Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input

“…Supplementary Table S1 and Table summarize the publications reviewed and outcomes, respectively . In brief, 31 publications reported the use of levodopa in 148 pregnancies, with examples of reported adverse outcomes including congenital malformation (n = 8) and seizures .…”

Management of Pregnancy and Childbirth in a Cervical Dystonia Patient with an Implanted Deep Brain Stimulation System

“…By contrast, some had a problem-free pregnancy. [ 5 6 ] None of the studies provided details about the charging processes during pregnancy. There was no change in the baby's movements or heart rate during charging periods in our patient.…”

“…reported that only three of seven patients experienced worsening of dystonia symptoms during pregnancy, and these symptoms resolved within 3 months after birth. [ 6 ] Two of these patients were diagnosed with isolated segmental dystonia, while the third was diagnosed with isolated hemidystonia. Meanwhile, in the study of Paluzzi et al ., none of the pregnant patients ( n = 3) experienced worsening of symptoms.…”

“…Hence, the baby had low birth weight. [ 6 ] In light of the current literature, pregnant women with implanted DBS systems should deliver their babies at the hospital, not at home. In our case, cesarean section under general anesthesia was planned based on the request of the patient because she is afraid to give birth via normal delivery.…”

“…Previous studies comprise case series in which the DBS system was turned off during delivery. [ 5 6 ] In patients with a DBS system, complete closure of stimulation is recommended during any surgical procedure. [ 8 9 10 ] In our case, the stimulation was shut down just before delivery and reactivated after delivery.…”