Conditions and Treatments

If you have epilepsy or another seizure disorder, you require special treatment during pregnancy that is carefully balanced to ensure the health of you and your baby. Large seizures can increase the risk of miscarriage and possibly affect the development of your baby. The good news is that we can help you become seizure-free prior to pregnancy, which improves your chances of avoiding seizures during pregnancy, and help you breastfeed safely after delivery. Our epileptologist partners with you to care for the following conditions:

• Absence seizures.
• Atonic seizures.
• Catamenial epilepsy (CE).
• Clonic seizures.
• Epilepsy.
• Febrile seizures.
• Focal seizures.
• Focal impaired aware seizures.
• Generalized epilepsy.
• Preeclampsia induced seizures.

Our care approach to epilepsy in pregnancy

We provide tailored individualized treatments to optimize your health. We manage your medication type and amount in the safest possible manner to lower the risk of seizure during pregnancy for the health of you and your baby. When your condition is complex, our epileptologist works in tandem with other specialized adult neurologists and other experts to get your seizures under control. For example, minimally invasive neurosurgery before you conceive can improve epilepsy during pregnancy, and stimulation therapy or our proven deep brain stimulation can calm seizures.

Migraine is the most common condition we treat during pregnancy. If you suffer from migraine, you may think you need to avoid pregnancy for fear that your symptoms will worsen. In fact, nearly 80% of women find that their migraine improves during pregnancy. We have an abundance of tools and strategies, including integrative medicine and medications and devices considered safe in pregnancy, to lower your risk of headache and facial pain and safely control your symptoms.

Our headache and facial pain specialist partners with you to care for the following conditions:

• Cluster headache.
• Idiopathic intracranial hypertension (IIH).
• Spontaneous intracranial hypotension (SIH).
• Migraine.
• New daily persistent headache (NDPH).
• Post-traumatic headache.
• Tension-type headache.
• Occipital neuralgia.
• Trigeminal neuralgia.

Our care approach to headaches in pregnancy

Through nuanced care, we find what best brings you relief. We partner with you to decide what treatment is best for you, adjusting it along the way as needed and ensuring that it is safe for your unborn baby. For example, if you experience occipital neuralgia (shooting pain generally from the base of the neck), we can consider administering an occipital nerve block to safely help reduce your pain during pregnancy.

A misconception exists that if you have multiple sclerosis (MS), neuromyelitis optica (NMO), or autoimmune encephalitis, you cannot carry a pregnancy to term or have a natural delivery. This is simply not true; however, you do require specialized care. Our in-depth experts help stabilize your autoimmune condition before, during, and after pregnancy for optimal outcomes. Our neuro-immunologist partners with you to care for the following conditions:

• Multiple sclerosis (MS).

Central nervous system autoimmune conditions:

• Anti-myelin oligodendrocyte glycoprotein antibody disease (MOGAD).
• Acute disseminated encephalomyelitis (ADEM).
• Autoimmune encephalitis (AE).
• Central nervous system (CNS) vasculitis.
• Neuromyelitis optica (NMO).
• Neurosarcoidosis.
• Optic neuritis.
• Transverse myelitis.
• Neuro-rheumatological conditions.

Our care approach to multiple sclerosis and central nervous system autoimmune conditions in pregnancy

We partner with you to have a successful pregnancy planning, conception, pregnancy, and delivery. Prior to conception, we provide fine-tuned, personalized care for multiple sclerosis or other central nervous system autoimmune conditions to help you achieve remission, often in partnership with the Stanford Medicine Children’s Health Fertility and Reproductive Health team. We then follow you closely during pregnancy, adjusting your care as needed to relieve your symptoms and protect your developing baby. Our care continues after delivery when your risk of relapse is especially high. In addition, we work with you closely to achieve successful breastfeeding if able and desired, re-initiating immune therapy, and monitoring disease activity.

If your doctor suspects a nerve or muscle condition, it’s important to get evaluated by our program prior to pregnancy. There are numerous neuromuscular conditions ranging from simple to complex. Some begin before pregnancy, while others occur during pregnancy. Many of these conditions benefit from specialized pregnancy care. Our neuromuscular neurologists can diagnose and treat conditions such as:

• Charcot-Marie-Tooth (CMT) disease.
• Chronic inflammatory demyelinating polyneuropathy (CIDP).
• Guillain-Barré syndrome (GBS).
• Immune myositis.
• Immune nerve diseases.
• Lambert-Eaton myasthenic syndrome.
• Muscular dystrophies.
• Myasthenia gravis (MG).
• Myopathy.
• Neuroleptic malignant syndrome.
• Peripheral nerve trauma and injury, and other neuropathies.
• Pinched nerves.
• Spinal cord conditions.

Our care approach to neuromuscular conditions in pregnancy

We carefully tailor our care to fit your neuromuscular condition before, during, and after pregnancy. In some cases, this includes pre-conception counseling and genetic testing to help identify any genetic conditions that may affect you and your future baby. Our goal is to provide support, information, and insight to empower you to make the right care decisions for you.

The physiological changes in pregnancy can increase your risk of stroke and blood clots, especially if you have any history of cerebrovascular disease or significant risk factors. While these complications can occur at any time during pregnancy, stroke and vascular disorders are most often observed at the end of the third trimester through the postpartum period. We recognize the importance for you to receive specialized stroke treatment before, during, and after pregnancy. With support and our multifaceted care, many women with a history of stroke and other vascular disorders are able to have a baby naturally. We also follow you after delivery to ensure that your personal health is well supported so you can also focus on your new baby.

Our Pregnancy Neurology Program vascular neurologist partners with you as well as other subspecialists to provide comprehensive care for the following conditions, among others:

• History of ischemic or hemorrhagic stroke.
• Hypercoagulability (thrombophilia) with stroke.
• Cerebral venous sinus thrombosis.
• Connective tissue disorders, such as fibromuscular dysplasia.
• Pregnancy-related cardiac disease.
• Hypertensive disorders of pregnancy with vascular complications.
• Posterior reversible encephalopathy syndrome (PRES).
• Reversible cerebral vasoconstriction syndrome (RCVS).
• History of vascular dissection.
• Other vasculopathies including intracranial stenosis and moyamoya disease.
• Cerebral aneurysm.
• Vascular malformations.

Our care approach to stroke in pregnancy

We investigate the source of your stroke or lesion and risk factors for future strokes, then select just the right treatment plan to mitigate the risk of complications during pregnancy, including addressing risks to your unborn baby. Many of our patients have other associated conditions, so we take a multispecialty approach. For example, stroke can be associated with blood clotting disorders and cardiac conditions, so we may recommend that you see specialists in these areas as well. We also partner with other neurologists in Comprehensive Neurology at Stanford Health Care when you have multiple or complex conditions or are best served by a holistic neurological approach.