Neurological conditions in pregnancy

Pregnancy can influence the clinical course of an underlying neurological problem or precipitate the first presentation of a neurological disease. This chapter looks at the various ways pregnancy can affect those suffering from epilepsy, multiple sclerosis, or cerebrovascular disease. In epilepsy, sodium valproate is associated with higher risk of major congenital malformations and impaired neuropsychological development than other antiepileptic drugs: lamotrigine or levetiracetam are preferred. Women taking antiepileptic drugs can breastfeed. In multiple sclerosis, the relapse rate is reduced in pregnancy, but substantially increased for three months post-partum. For cerebrovascular disease, stroke syndromes specific to pregnancy include pre-eclampsia, which can lead to posterior reversible vasoconstriction syndrome. Reversible cerebral vasoconstriction syndrome presents after delivery and has many similarities to posterior reversible vasoconstriction syndrome. There are conflicting opinions as to whether pregnancy or delivery increases the risk of cerebral aneurysm or arteriovenous malformation rupture.