Deep Brain Stimulation during Pregnancy and Delivery: Experience from a Series of “DBS Babies”

Abstract

IntroductionDeep brain stimulation (DBS) is widely used to improve quality of life in movement disorders (MD) and psychiatric diseases. Even though the ability to have children has a big impact on patients’ life, only a few studies describe the role of DBS in pregnancy.ObjectiveTo describe risks and management of women treated by DBS for disabling MD or psychiatric diseases during pregnancy and delivery.MethodsWe report a retrospective case series of women, followed in two DBS centers, who became pregnant and went on to give birth to a child while suffering from disabling MD or psychiatric diseases [Parkinson’s disease, dystonia, Tourette’s syndrome (TS), Obsessive Compulsive Disorder (OCD)] treated by DBS. Clinical status, complications and management before, during, and after pregnancy are reported. Two illustrative cases are described in greater detail.ResultsDBS improved motor and behavioral disorders in all patients and allowed reduction in, or even total interruption of disease-specific medication during pregnancy. With the exception of the spontaneous early abortion of one fetus in a twin pregnancy, all pregnancies were uneventful in terms of obstetric and pediatric management. DBS parameters were adjusted in five patients in order to limit clinical worsening during pregnancy. Implanted material limited breast-feeding in one patient because of local pain at submammal stimulator site and led to local discomfort related to stretching of the cable with increasing belly size in another patient whose stimulator was implanted in the abdominal wall.ConclusionNot only is it safe for young women with MD, TS and OCD who have a DBS-System implanted to become pregnant and give birth to a baby but DBS seems to be the key to becoming pregnant, having children, and thus greatly improves quality of life.

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

“…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 . Two publications provided results of genetic testing, including a total of 4 cases with Parkin mutations . Of the 109 levodopa‐exposed pregnancies for which outcomes were available, 83% resulted in live births (n = 91), 8% were electively terminated (n = 9), and 9% resulted in spontaneous abortion (n = 10).…”

“…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 .…”

“…The largest case series of DBS during pregnancy identified 11 individuals with 18 births (PD = 3, dystonia = 5, Tourette's syndrome = 2, obsessive‐compulsive disorder = 1). Of the 3 cases diagnosed with PD, 1 stopped her medication during pregnancy and resumed at the same dose postpartum, another changed from a dopamine agonist to levodopa and back to a dopamine agonist postpartum, and the third continued her treatment of a dopamine agonist and MAO inhibitor throughout . None of these women breastfed in the postpartum period owing to concerns of the impact of their oral medical therapy.…”

Young Onset Parkinson’s Disease: A Modern and Tailored Approach

“…Amantadine should be avoided as it has been associated with teratogenicity in both animal and human studies [46]. The effects of DBS seems to be safe although data are based on a small number of cases [47]. Compared to the normal population, there appears to be no differences in deliveries by women with YOPD [45].…”

Deep Brain Stimulation during Pregnancy and Delivery: Review of Current Literature

“…Scelzo et al did not specifically mention the method of hemostasis. 9 Park et al recommended the use of bipolar coagulation at least 15 cm away from the implanted generator, connecting cables, or intracerebral electrodes. Although these conditions are very difficult to meet in a neurosurgical revision of a DBS system, we consider these safety limits acceptable for an emergency cesarean section performed by a surgeon with minimal experience with DBS systems.…”