Neurological disorders in pregnancy

Neurological disorders are a significant cause of morbidity and mortality in pregnancy. In the UK between 2003 and 2005, women with neurological conditions accounted for 37 out of a total 87 ‘indirect’ maternal deaths (those not arising from pregnancy or birth), with stroke (n = 24) and epilepsy (n =11)1 accounting for the majority of deaths from neurological causes2. Neurological assessment can distinguish between neurological symptoms that are common in pregnancy (such as dizziness, pain and urinary frequency) and those that might indicate a more significant disorder. Neurological conditions can arise from ‘organic’ disorders, which are usually associated with clear-cut abnormalities with neurological investigations, but may also result from less well understood ‘functional’ problems, typically causing pain, fatigue or even alteration in levels of consciousness. All neurological conditions may present both medical and obstetric challenges to clinicians unfamiliar with their management within the context of pregnancy. Fortunately, the natural history of key neurological conditions has been observed during pregnancy, providing a useful basis on which to counsel women and organize services. Less information is available about the safety of neurological treatments or investigations during pregnancy or obstetric and neonatal outcomes for these women. Therefore, many decisions rely on applying key obstetric and neurological principles to situations where published data are not available. This chapter outlines neurological assessment and investigation in pregnancy before considering the most common and important neurological presentations – multiple sclerosis, stroke, epilepsy and pain. These conditions arise from different pathologies, but their management allows the basic principles of management of other neurological conditions to be described. Overall women with preexisting neurological conditions, or women who present with neurological symptoms during pregnancy rely on good communication between their obstetrician, neurologist, physician, neonatologist and anesthetist to achieve optimal obstetric and neonatal outcomes.