Neurologische Erkrankungen und Schwangerschaft – eine Übersicht

Zusammenfassung

Neurologische Erkrankungen, die durch eine Schwangerschaft ausgelöst werden, sind das posteriore reversible Enzephalopathiesyndrom (PRES), das Fruchtwasser-Embolie-Syndrom, das Sheehan-Syndrom und die Post-partum-Angiopathie – das reversible zerebrale Vasokonstriktionssyndrom (RCVS). Zu den diagnostischen Kriterien der Präeklampsie zählen Blutdruckerhöhung und Proteinurie; bei epileptischen Anfällen liegt eine Eklampsie vor. Hämolyse, erhöhte Leberenzyme und niedrige Thrombozytenzahlen (low platelets) sind Leitsymptome des HELLP-Syndroms. Sehstörungen bis zur kortikalen Blindheit charakterisieren das posteriore reversible Enzephalopathiesyndrom (PRES). Das Sheehan-Syndrom zeigt sich als Hypopituitarismus post partum und kommt durch einen Apoplex der Hypophyse bei peripartalen Blutungen mit längerfristigem Blutdruckabfall zustande. Zu den neurologischen Krankheiten, die während einer Schwangerschaft gehäuft auftreten, zählen Schlaganfälle, die Sinusvenenthrombose, das Restless-Legs-Syndrom und Nervenkompressionssyndrome. Chronische neurologische Erkrankungen müssen während einer Schwangerschaft interdisziplinär überwacht und betreut werden. Die Einnahme von Antikonvulsiva während der Schwangerschaft verdoppelt das Risiko von Geburtsdefekten; das höchste Risiko besteht für Valproinsäure. Das geringste Fehlbildungsrisiko weisen Lamotrigin und Levetiracetam auf. Bei MS-Patientinnen sind nach Registerdaten Glatirameracetat und Interferone als Intervalltherapeutika während der Gravidität relativ sicher. Alle anderen Substanzen sollten abgesetzt werden.

Abstract

Neurological disorders caused by pregnancy and puerperium include the posterior reversible encephalopathy syndrome, the amniotic fluid embolism syndrome (AFES), the postpartum angiopathy due to reversible vasoconstriction syndrome, and the Sheehan syndrome. Hypertension and proteinuria are the hallmarks of preeclampsia, seizures define eclampsia. Hemolysis, elevated liver enzymes and low platelets constitute the HELLP syndrome. Vision disturbances including cortical blindness occur in the posterior reversible encephalopathy syndrome (PRES). The Sheehan syndrome presents with panhypopituitarism post partum due to apoplexia of the pituitary gland in severe peripartal blood loss leading to longstanding hypotension. Some neurological disorders occur during pregnancy and puerperium with an increased frequency. These include stroke, sinus thrombosis, the restless legs syndrome and peripheral nerve syndromes, especially the carpal tunnel syndrome. Chronic neurologic diseases need an interdisciplinary approach during pregnancy. Some anticonvulsants double the risk of birth defects. The highest risk exists for valproic acid, the lowest for lamotrigine and levetiracetam. For MS interval treatment, glatiramer acetate and interferones seem to be safe during pregnancy. All other drugs should be avoided.

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