Parkinsonism & tremors in Pregnancy: By Dr. De Leon

Just the other day, I wrote about the gender differences in Parkinson’s ….and today I open my mail and I get a whole journal about gender issues particularly that of neurology of pregnancy of various diseases which covered some of the movement disorders.

As I wrote previously, not a lot is known about pregnancy and Parkinson. In this huge journal less than one page was dedicated to this topic which tells me we still have a long way to go in understanding role pregnancy plays in Parkinson’s pathology and physiology.

As I mentioned in my blog on gender differences of PD , evidence of estrogen effects on PD is conflicting to say the least according to the experts. The opinions on whether is beneficial or detrimental are all over the spectrum depending on the different patients evaluated ranging from improvement, worsening and no change in motor symptoms. In a study of 36 pregnancies, 27 ( which was a total of 47% ) of them had either worsening which also included appearance of new symptoms of PD during or shortly after delivery. However, hard to say if this is true considering that this study involved only a very small group. Further studies are need to evaluate if indeed pregnancy tends to worsen symptoms or bring forth new symptoms. Good news, however, from this small study the patients often returned to baseline after delivery.

Only one report in literature has occurred of De novo onset of Parkinsonism at 11 weeks gestation of unclear etiology which resolved spontaneously after delivery!

On the other hand, unlike parkinson’ s, tremor may occur in pregnancy as a consequence of increased physiological tremor, from essential tremors or from drug induced tremor caused by agents that cause increase in adrenaline (sympathomimetics).

Essential tremor is the most common inherited movement disorder, characterized by action tremors usually affecting both hands but more common in one side. Tremors are worst with affeine and improve with alcohol (but I am not recommending you start drinking to self medicate!) [ as an aside, for people who are alcoholics and present with severe action tremors to the doctors office a big majority of them with proper questioning will tell you that they started drinking to mitigate their tremors subsequently becoming alcoholics! & thus tremors NOT caused by alcohol but essential].

Because most drugs used to treat tremors are a high risk during pregnancy particularly during first trimester and even throughout the duration of pregnancy. Only patients with disabling tremors should consider treatment.

Both groups [PD & ET] must discuss with their physicians if are at childbearing age especially if contemplating having children. But, MUST do so PRIOR to TRYING TO have children because in most or the majority of medications especially for tremors the damage can already be done by the time people find out they are pregnant in first trimester!
Also need to discuss if planning on breast feeding as most medications are also contraindicated!

Unfortunately, only Nebraska State has a pregnancy registry for Parkinson’s
As far as I know, there is no ET, pregnancy registry…

Here is a list of meds for PD and their FDA categories

Drug. FDA Pregnancy category Breast -Feeding
Levodopa. C. Do not use-no data on milk
Rotigotine. C. No human data
Amantadine C. Do not use
Artane. C. No data on excretion (milk)
Pramipexole C. Do not use
Ropinirole. C. Do not use -it is excreted in
Breast milk.

According to US Food & Drug Administration – Assigned Pregnancy Categories as used in drug formularies

Category A, B, C,D, & X

C : means that animal reproduction studies have revealed an adverse effect on the fetus and there are no adequate and well controlled studies in humans but potential benefits may warrant use of the drugs in pregnant women despite risks.

For more information on this topic go to: Demirkian M, Aslan K, Bicakci S, et al. Transient parkinsonism: Induced by progesterone or pregnancy? Mov Disord 2004; 19(11):1382-1384.

Scott M, Chowdhury M. Pregnancy in Parkinson’s disease; unique case report and review of the literature. Mov Disord 2005; 20(8):1078-1079.

Morgan JC, Sethi KD, Drug-induced tremors. Lancet Neurol 2005; 4(12):866-876.

Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update; treatment of essential tremor. neurology 2011;77919);1752-1755.

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com
may also contact me at
deleonenterprises3@yahoo.com