title: Pregnancy in a Series of Dystonia Patients Treated with Deep Brain Stimulation: Outcomes and Management Recommendations.
abstract: BACKGROUND
  Medically refractory dystonia affects children and young adults, and deep brain stimulation (DBS) can allow some patients to regain functional independence. Women with dystonia treated with DBS may wish to conceive a child, but there is limited published information on pregnancy and DBS.
  
  
  OBJECTIVE
  To describe a series of dystonia patients treated with DBS who later became pregnant and provide guidelines for women treated with DBS considering conception.
  
  
  METHODS
  We reviewed all dystonia DBS cases implanted at the University of California, San Francisco, and University of Alabama at Birmingham from 1998 to 2015 and identified patients who became pregnant. Patient records were reviewed and structured interviews were conducted.
  
  
  RESULTS
  Six dystonia patients were identified [1 currently pregnant and 7 live births (including 1 twin pair)]. Patients (n = 5) with pre- and postoperative BFMDRS (Burke-Fahn-Marsden Dystonia Rating Scale) scores improved by 65.9% after DBS. All pregnancies and deliveries were uncomplicated (the delivery mode was not influenced by the presence of DBS), except for 1 child, who was born premature at 35 weeks' gestation. Stimulation remained on (n = 3) or off (n = 4) during deliveries. DBS neurostimulators did not hinder breastfeeding.
  
  
  CONCLUSIONS
  In this small sample, pregnancy, delivery, and breastfeeding were safe in dystonia patients treated with DBS. The presence of DBS should not be a contraindication to pregnancy.
authors.affiliation: Department of Neurology, University of California, San Francisco, Movement Disorder and Neuromodulation Center, San Francisco, Calif., USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ziman
authors.forename: Robert R
authors.initials: RR
authors.lastname: Coleman
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
authors.forename: Monica
authors.initials: M
authors.lastname: Volz
authors.forename: William J
authors.initials: WJ
authors.lastname: Marks
authors.forename: Harrison C
authors.initials: HC
authors.lastname: Walker
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Guthrie
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation; D004421:Dystonia / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome