Is primary orthostatic tremor associated with an autochthonous immunoglobulin synthesis in the cerebrospinal fluid?
✍ Scribed by Joerg Spiegel; Gerhard Fuss; Ulrich Dillmann
- Publisher
- John Wiley and Sons
- Year
- 2005
- Tongue
- English
- Weight
- 44 KB
- Volume
- 20
- Category
- Article
- ISSN
- 0885-3185
No coin nor oath required. For personal study only.
✦ Synopsis
According to the British National Formulary, all antiparkinsonian medications are contraindicated during pregnancy. 8 The published literature on the impact and safety of L-dopa/carbi- dopa and dopamine agonists for PD during pregnancy is scarce. With regard to other antiparkinsonian drugs in pregnancy, four cases of treatment with amantadine during pregnancy have been reported, all associated with complications, including two miscarriages. Many authors advise a high level of caution regarding the use of amantadine in pregnancy because of a strong link to a case of cardiovascular malformation and strong evidence from animal studies suggesting teratogenicity. 3,6,9 Pregnancy in PD is an uncommon occurrence. Nevertheless, there is a need to give appropriate education or information to enable women with PD who become or wish to become pregnant to make an informed choice as to how they proceed. The absence of clinical trials involving the use of anti-Parkinson's medication in pregnancy means the relative safety of these drugs remains uncertain. The small number of reports makes it difficult to provide clear evidence-based guidance.
The absence of any strong evidence surrounding the safety of dopamine agonists is of some concern, as guidelines for the management of PD in younger patients tend to steer clinicians toward these "newer" forms of therapy. The number of patients on this form of therapy becoming or wishing to become pregnant is likely to rise in the future.
There is clearly a need for more evidence to be gathered. We believe that the setting up of a database of all reported pregnancies amongst women with PD would over time produce a large store of useful data. Feedback from neurologists, general practitioners, physicians, and nurse specialists on the symptomatic progress of individual patients, their medication regimes, and pregnancy outcomes could be collated relatively easily and examined. This data could then be used to develop appropriate evidence-based guidelines on drug treatment for PD during pregnancy.