This book is a practical and easily readable guide for neurologists, obstetricians, and primary care doctors treating female patients with neurological illness in their reproductive years.
Offers wide ranging coverage, including family planning and lactation
Presents information in approachable tables and summaries, focusing on high yield information useful for clinical consultation
Is written by a team of experts and edited by recognized leaders in the field
Autumn Klein
University of Pittsburgh Medical Center, Pittsburgh, USA
M. Angela O'Neal
Brigham and Women's Hospital, Boston, USA
Christina Scifres
University of Oklahoma College of Medicine, Oklahoma City, OK, USA
Janet Waters
University of Pittsburgh Medical Center, Pittsburgh, USA
Jonathan H. Waters
Magee Women's Hospital of University of Pittsburgh Medical Centre, Pittsburgh, USA
Autorentext
Autumn Klein
University of Pittsburgh Medical Center, Pittsburgh, USA
M. Angela O'Neal
Brigham and Women's Hospital, Boston, USA
Christina Scifres
University of Oklahoma College of Medicine, Oklahoma City, OK, USA
Janet Waters
University of Pittsburgh Medical Center, Pittsburgh, USA
Jonathan H. Waters
Magee Women's Hospital of University of Pittsburgh Medical Centre, Pittsburgh, USA
Leseprobe
CHAPTER 1
The history and examination
Mary A. O'Neal
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Introduction
The focus of this chapter will be on the information most helpful to understand, counsel, and treat female neurology patients in their reproductive years. The key elements of the neurologic history and examination will be systematically reviewed with emphasis on gender differences. It will conclude with a few clinical cases. The goal is to enable neurologists to develop the knowledge and skills to maximize care for their female patients with regard to family planning and pregnancy. The objective of this chapter is to help physicians to perform a history and examination that focuses on and identifies the specific family planning concerns of the female patient and how these concerns relate to their neurologic disease.
Many common neurological diseases preferentially affect young women. How we, as neurologists, approach treatment depends on our patients' needs at that point in her life cycle. This is different for each disease process.
Migraine is a very common disorder with lifetime prevalence in women of up to 25%. Because of hormonal influences, the ratio of affected women over men is 3:1 [ 1]. The history should include usual triggers, of which menses and ovulation are common. Birth control pills (BCPs) have a variable influence on migraine frequency and in some women may aggravate the disorder [ 2]. However, many women with menstrual headaches report that cycle suppression (which can be obtained using the subdermal implant, injectable contraception, a pill, patch, or ring) improves their symptoms. The type of migraine is important when discussing contraception. Women with classic migraines should be counseled to avoid estrogen-containing contraceptives (e.g., the pill, patch, or ring), given the increased risk of ischemic stroke. However, common migraine does not preclude use of estrogen-containing contraceptives unless associated with other cerebrovascular risk factors such as an underlying hypercoaguable state. [ 3] Furthermore, when choosing medications (abortive or prophylactic), you should take into account, whether the woman are trying to get pregnant, or, if not trying to conceive, what birth control they are utilizing. For instance, topiramate in doses above 200 mg/day may reduce the effectiveness of oral contraceptives [ 4]. Does the patient have regular menses? Could she have polycystic ovarian syndrome? If so, Valproate would not be a good choice as a prophylactic medication [ 5]. Another concern with patients already predisposed to obesity is that many prophylactic medications can contribute to weight gain.
Multiple sclerosis is another example of a neurologic disease that affects women in their childbearing years [ 6]. Many of these patients are on an immunomodulatory medication. Interferons are pregnancy class C, copaxone pregnancy class B, and methotrexate a pregnancy class D medication. Because immunomodulatory medications are not recommended during pregnancy, birth control should be discussed if the woman is not planning pregnancy. What should we recommend to our patients who would like to become pregnant? [ 7] They should discontinue their immunomodulatory medication when they discontinue their hormonal or intrauterine contraceptive, as the only contraceptive that typically delays return to fertility is depot medroxyprogesterone acetate. They should be counseled that pregnancy does not worsen overall MS disability [ 8] Treatment needs to be appropriately adjusted to best address our patient's needs at each particular point in her life cycle.
Past medical history
Patients' medical background allows us to frame a more accurate diagnosis for their current complaints. The disorders from which women suffer are different from those that affect men. A woma
Inhalt
Offers wide ranging coverage, including family planning and lactation
Presents information in approachable tables and summaries, focusing on high yield information useful for clinical consultation
Is written by a team of experts and edited by recognized leaders in the field
Autumn Klein
University of Pittsburgh Medical Center, Pittsburgh, USA
M. Angela O'Neal
Brigham and Women's Hospital, Boston, USA
Christina Scifres
University of Oklahoma College of Medicine, Oklahoma City, OK, USA
Janet Waters
University of Pittsburgh Medical Center, Pittsburgh, USA
Jonathan H. Waters
Magee Women's Hospital of University of Pittsburgh Medical Centre, Pittsburgh, USA
Autorentext
Autumn Klein
University of Pittsburgh Medical Center, Pittsburgh, USA
M. Angela O'Neal
Brigham and Women's Hospital, Boston, USA
Christina Scifres
University of Oklahoma College of Medicine, Oklahoma City, OK, USA
Janet Waters
University of Pittsburgh Medical Center, Pittsburgh, USA
Jonathan H. Waters
Magee Women's Hospital of University of Pittsburgh Medical Centre, Pittsburgh, USA
Leseprobe
CHAPTER 1
The history and examination
Mary A. O'Neal
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Introduction
The focus of this chapter will be on the information most helpful to understand, counsel, and treat female neurology patients in their reproductive years. The key elements of the neurologic history and examination will be systematically reviewed with emphasis on gender differences. It will conclude with a few clinical cases. The goal is to enable neurologists to develop the knowledge and skills to maximize care for their female patients with regard to family planning and pregnancy. The objective of this chapter is to help physicians to perform a history and examination that focuses on and identifies the specific family planning concerns of the female patient and how these concerns relate to their neurologic disease.
Many common neurological diseases preferentially affect young women. How we, as neurologists, approach treatment depends on our patients' needs at that point in her life cycle. This is different for each disease process.
Migraine is a very common disorder with lifetime prevalence in women of up to 25%. Because of hormonal influences, the ratio of affected women over men is 3:1 [ 1]. The history should include usual triggers, of which menses and ovulation are common. Birth control pills (BCPs) have a variable influence on migraine frequency and in some women may aggravate the disorder [ 2]. However, many women with menstrual headaches report that cycle suppression (which can be obtained using the subdermal implant, injectable contraception, a pill, patch, or ring) improves their symptoms. The type of migraine is important when discussing contraception. Women with classic migraines should be counseled to avoid estrogen-containing contraceptives (e.g., the pill, patch, or ring), given the increased risk of ischemic stroke. However, common migraine does not preclude use of estrogen-containing contraceptives unless associated with other cerebrovascular risk factors such as an underlying hypercoaguable state. [ 3] Furthermore, when choosing medications (abortive or prophylactic), you should take into account, whether the woman are trying to get pregnant, or, if not trying to conceive, what birth control they are utilizing. For instance, topiramate in doses above 200 mg/day may reduce the effectiveness of oral contraceptives [ 4]. Does the patient have regular menses? Could she have polycystic ovarian syndrome? If so, Valproate would not be a good choice as a prophylactic medication [ 5]. Another concern with patients already predisposed to obesity is that many prophylactic medications can contribute to weight gain.
Multiple sclerosis is another example of a neurologic disease that affects women in their childbearing years [ 6]. Many of these patients are on an immunomodulatory medication. Interferons are pregnancy class C, copaxone pregnancy class B, and methotrexate a pregnancy class D medication. Because immunomodulatory medications are not recommended during pregnancy, birth control should be discussed if the woman is not planning pregnancy. What should we recommend to our patients who would like to become pregnant? [ 7] They should discontinue their immunomodulatory medication when they discontinue their hormonal or intrauterine contraceptive, as the only contraceptive that typically delays return to fertility is depot medroxyprogesterone acetate. They should be counseled that pregnancy does not worsen overall MS disability [ 8] Treatment needs to be appropriately adjusted to best address our patient's needs at each particular point in her life cycle.
Past medical history
Patients' medical background allows us to frame a more accurate diagnosis for their current complaints. The disorders from which women suffer are different from those that affect men. A woma
Inhalt
Notes on contributors, vi
Preface, ix
1 The history and examination, 1
Mary A. O'Neal
2 Hormonal and physiologic changes in pregnancy, 9
Janet F. R. Waters
3 Neuroimaging, 15
William T. Delfyett & David T. Fetzer
4 Neurologic complications in the obstetrical anesthesia patient, 70
Olajide Kowe & Jonathan H. Waters
5 Headaches during pregnancy and peripartum, 80
Huma Sheikh
6 Stroke in pregnancy and the puerperium, 92
Louis R. Caplan & Diogo C. Haussen
7 Selecting contraception for women treated with antiepileptic drugs, 110
Page B. Pennell & Anne Davis
8 Epilepsy, 122
Mark S. Yerby
9 Multiple sclerosis, 142
Aiden Haghikia & Kerstin Hellwig
10 Neuromuscular disorders, 153
Mohammad Kian Salajegheh & Kathy Chuang
11 Anterior and posterior pituitary disease and pregnancy, 167
Mark E. Molitch
12 Movement disorders and pregnancy, 179
Sathiji Nageshwaran, Marsha Smith, & Yvette M. Bordelon
13 Brain tumors and pregnancy, 191
Soma Sengupta & Elizabeth Gerstner
14 Neuro-ophthalmology in pregnancy, 201
Linda P. Kelly, Nancy J. Newman, & Val´erie Biousse
15 Neurological infections in pregnancy, 213
Shibani S. Mukerji & Jennifer L. Lyons
16 Neurosurgery, 234
Judith M. Wong, Anil Can, & Rose Du
17 Sleep disorders, 243
Sally Ibrahim & Nancy Foldvary-Schaefer
18 Neurourology of pregnancy, 258
Kimberly L. Ferrante, Victor W. Nitti, & Benjamin M. Brucker
Index, 269
Titel
Neurological Illness in Pregnancy
Untertitel
Principles and Practice
Editor
EAN
9781118430897
ISBN
978-1-118-43089-7
Format
E-Book (epub)
Hersteller
Herausgeber
Veröffentlichung
25.11.2015
Digitaler Kopierschutz
Adobe-DRM
Dateigrösse
3.39 MB
Anzahl Seiten
288
Jahr
2015
Untertitel
Englisch
Unerwartete Verzögerung
Ups, ein Fehler ist aufgetreten. Bitte versuchen Sie es später noch einmal.