Eric A.P. Steegers - Neurology and Pregnancy: Neuro-Obstetric Disorders

First edition

Eric A.P. Steegers

Marilyn J. Cipolla

Eliza C. Miller

Michael J. Aminoff

Franois Boller

Dick F. Swaab

Pregnancy and childbirth directly concern a sizeable portion of the world's population. The nervous system participates in these processes in many ways and makes them possible through hormonal changes. In addition, any treatment of a pregnant patient may have important and often long-term consequences for the developing fetus. Yet, standard neurology textbooks often fail to discuss these topics in any depth. The previous series of the Handbook of Clinical Neurology (HCN) had close to 100 entries under the indexed heading of Pregnancy, but these usually consisted of footnotes added to the discussion of major disorders such as headache or epilepsy. Therefore we are proud to introduce the present two volumes dedicated to various aspects of neurology and pregnancy.

The first volume is dedicated to the neurophysiologic changes that accompany pregnancy, an overview of the neurologic and psychiatric diseases seen during that period, and the approach to the care of these conditions. A chapter entitled Neuro-obstetrics emphasizes the need for a multidisciplinary approach to the care of women with neurologic comorbidities, both preconceptionally and throughout pregnancy. Other chapters discuss in detail neuroimaging and radiation exposure during pregnancy as well as the ethical aspects of complicated pregnancies. The volume concludes with a discussion of the diagnosis and management of congenital neurologic diseases during pregnancy.

The second volume deals in detail with neurologic disorders that may accompany pregnancy, such as stroke, trauma, and neurologic complications associated with preeclampsia and eclampsia. There are chapters that discuss compression neuropathies, acute psychiatric illnesses, migraine and other headaches, movement disorders, disorders of sleep, and CNS tumors. Moreover, a chapter is dedicated to the management of chronic neurologic disorders during pregnancy.

We have had the good fortune of working with three experienced and world-renowned volume editors. Prof. Eric A.P. Steegers is a gynecologist and the head of the Department of Obstetrics & Gynecology at the Erasmus University Medical Center in Rotterdam. Dr. Marilyn J. Cipolla is professor in the Department of Neurological Sciences with joint appointments in Obstetrics, Gynecology & Reproductive Sciences and Pharmacology at the University of Vermont Larner College of Medicine, Burlington. Dr. Eliza C. Miller is a vascular neurologist and assistant professor of neurology in the Division of Stroke and Cerebrovascular Disease at Columbia University, New York City. As series editors, we reviewed all the chapters in the volumes and made suggestions for improvement, but we are delighted that the volume editors and chapter authors produced such scholarly and comprehensive accounts of different aspects of the neurology of pregnancy. Hence, we hope that the volumes will appeal to clinicians and neuroscientists alike. Our goal is to provide clinicians with a state-of-the-art reference that summarizes the clinical features and management of the many neurologic manifestations of pregnancy. We also intend to provide basic researchers with the foundations for new approaches to the study of the complex changes that accompany pregnancy.

In addition to the print version, the chapters in the two volumes are also available electronically on Elsevier's ScienceDirect website, which is becoming increasingly popular with readers and will improve the book's accessibility. Indeed, all the volumes in the present series of Handbook are available electronically on this website. This will make them even more accessible to readers and facilitate searches for specific information.

As always, it is a pleasure to thank Elsevier, our publisher, and in particular Michael Parkinson in Scotland, Nikki Levy and Kristi Anderson in San Diego, and Punithavathy Govindaradjane at Elsevier Global Book Production in Chennai, for their assistance in the development and production of the Handbook of Clinical Neurology .

Eric A.P. Steegers

Marilyn J. Cipolla

Eliza C. Miller

Neurology and Pregnancy is a two-volume comprehensive multidisciplinary guide to best practices for neurologists, obstetricians, and other specialists who care for women with acute or chronic neurologic disorders. All aspects of care for the pregnant woman with neurologic illness, such as preconception care, genetic counseling, pregnancy in patients with chronic neurologic disorders, and acute pregnancy-related neurologic complications, are covered. Postpartum care and complications, including lactation concerns, are also addressed, as are the long-term effects of pregnancy and its associated problems on maternal brain health.

In the first volume (vol. 171 of the Handbook of Clinical Neurology ), the complex neurophysiologic changes in pregnancy are summarized from a basic and translational science perspective. This is followed by a discussion of general issues relevant to the provision of multidisciplinary neurologic care for pregnant patients, including neuroimaging, the principles of neuro-obstetric critical care, and ethical and medicolegal concerns. The final part describes normal fetal cerebral development and summarizes the management of the most common prenatal neurologic disorders.

The second volume (vol. 172 of the Handbook of Clinical Neurology ) covers acute neurologic disorders presenting in pregnancy, including preeclampsia/eclampsia, ischemic and hemorrhagic stroke, and infections of the central nervous system. This is followed by discussions of chronic neurologic conditions, such as epilepsy, migraine, and multiple sclerosis. As innovative care can be achieved only by the continuous integration of clinical management with advances in research, all chapters provide insights into the newest developments in related translational neuroscience and the implications for the future of the field.

The many contributors to this volume reflect diverse perspectives, from basic and translational researchers to clinicians and clinical researchers in a broad range of specialties. We are grateful to have been given the opportunity to learn and benefit from their extraordinary expertise. Michael Parkinson, the development editor, has thoughtfully provided vital support throughout the process of bringing this work to publication.

We believe that this text will improve the complex multidisciplinary care needed for pregnant women with neurologic disorders, contribute to improved maternal and fetal outcomes, and enhance the long-term health of mothers affected by neurologic disease and also that of their children.