J Korean Med Sci.  2017 Jan;32(1):155-159. 10.3346/jkms.2017.32.1.155.

Pregnancy and Delivery in a Generalized Dystonia Patient Treated with Internal Globus Pallidal Deep Brain Stimulation: a Case Report

• Park HR
• Lee JM
• Park H
• Shin CW
• Kim HJ
• Park HP
• Kim DG
• Jeon BS
• Paek SH

• KMID: 2417599
• DOI: http://doi.org/10.3346/jkms.2017.32.1.155

Abstract

Internal globus pallidus (GPi) deep brain stimulation (DBS) has been widely accepted as an effective treatment modality of medically refractory dystonia. However, there have been few studies regarding the safety issue of pregnancy and childbirth related with DBS. This report describes a female patient who was pregnant and delivered a baby after GPi DBS surgery. A 33-year-old female patient with acquired generalized dystonia underwent bilateral GPi DBS implantation. She obtained considerable improvement in both movement and disability after DBS implantation. Four years later, she was pregnant and the obstetricians consulted us about the safety of the delivery. At 38-weeks into pregnancy, a scheduled caesarian section was carried out under general anesthesia. After induction using thiopental and succinylcholine, intubation was done quickly, followed by DBS turn off. For hemostasis, only bipolar electrocautery was used. Before awakening from the anesthesia, DBS was turned on as the same parameters previously adjusted. After delivery, she could feed her baby by herself, because the dystonia of left upper extremity and hand was improved. Until now, she has been showing continual improvement and being good at housework, carrying for children, with no trouble in daily life. This observation indicates that the patients who underwent DBS could safely be pregnant and deliver a baby.

Keyword

Deep Brain Stimulation; Dystonia; Globus Pallidus; Child Birth and Care

MeSH Terms

Adult
Anesthesia
Anesthesia, General
Child
Deep Brain Stimulation*
Dystonia*
Electrocoagulation
Female
Globus Pallidus
Hand
Hemostasis
Housekeeping
Humans
Intubation
Parturition
Pregnancy*
Succinylcholine
Thiopental
Upper Extremity
Succinylcholine
Thiopental

Figure

• 

  Fig. 1 Movie frames obtained from preoperative and postoperative video. (A) Movie frames obtained from a preoperative video showing the patient lifting both arms and walking. (B) Movie frame obtained from a postoperative video showing the same patient 7 years after deep brain stimulation (DBS) surgery.

• 

  Fig. 2 Postoperative imaging showing the location of the electrodes. (A) Postoperative magnetic resonance imaging (MRI) scans demonstrating the bilateral deep brain stimulation electrodes in the posteroventral internal globus pallidus (GPi) Axial fluid-attenuated inversion recovery (Axial FLAIR). (B) Postoperative assessment of implanted electrodes by image fusion of a postoperative computed tomography (CT) scan with the corresponding preoperative inversion-recovery image. The bilateral electrodes located in the external globus pallidus (GPe).

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