Neurological disease in pregnancy

Abstract

Neurological disease presents a particular challenge to those providing obstetric care, to minimise maternal, foetal and neonatal morbidity. Women with pre-existing neurological disease should ideally be given a preconceptual assessment in order to optimise medical management. Headache is an extremely common problem both during and outside of pregnancy and requires a structured approach. Some conditions, such as eclampsia, are unique to pregnancy, whereas others, such as carpal tunnel syndrome, are seen much more frequently but not exclusively in pregnancy. The drug management of epilepsy in pregnancy represents a particular challenge, balancing the desire to limit foetal exposure on the one hand, with the need to maintain therapeutic benefit to the mother on the other. Assessment of all neurological conditions requires a sound knowledge of neuroanatomy and the physiology of pregnancy, with appropriate use of neuroimaging and neurophysiological testing. Management should involve a multidisciplinary team with specialist neurological input.