Pregnancy in Parkinson's disease: Case report and discussion

Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street N4W46, Baltimore, MD 21201, USA.
Expert Review of Neurotherapeutics (Impact Factor: 2.78). 01/2009; 8(12):1799-805. DOI: 10.1586/14737175.8.12.1799
Source: PubMed


Pregnancy in Parkinson's disease (PD) is an uncommon occurrence. Available reports suggest that there may be a worsening of PD symptom severity related to pregnancy. In this special report, medical literature on pregnancy in PD will be reviewed with regard to disease progression and the safety of antiparkinsonian medications. A case report of pregnancy in a woman with PD will be described. It is speculated that the symptoms of PD may be affected by changing hormone levels.

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Available from: Roger J Mullins, Mar 09, 2015
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    • "A worsening of PD symptoms in menstrual women was reported in pre-menstrual and menstrual periods, when estrogen and progesterone levels are low [55] [127]. Several women with PD report a deterioration of their symptoms and the extensive variations in estrogen levels during and after pregnancy were suggested to be implicated in worsening of PD symptoms [107] [109]. Lower symptom severity scores were reported in women with early PD taking estrogen therapy , but not yet taking levodopa [113]; an effect that was not observed at later stages of the disease [122]. "
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    ABSTRACT: Studies with the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) animal model of Parkinson's disease have shown the ability of 17β-estradiol to protect the nigrostriatal dopaminergic system. This paper reviews the signaling pathways mediating the neuroprotective effect of 17β-estradiol against MPTP-induced toxicity. The mechanisms of 17β-estradiol action implicate activation of signaling pathways such as the phosphatidylinositol-3 kinase/Akt and the mitogen-activated protein kinase pathways. 17β-estradiol signaling is complex and integrates multiple interactions with signaling molecules that act to potentiate a protective effect. 17β-estradiol signaling is mediated via estrogen receptors, including GPER1, but others receptors, such as the IGF-1 receptor, are implicated in the neuroprotective effect. Glial and neuronal crosstalk is a critical factor in the maintenance of dopamine neuronal survival and in the neuroprotective action of 17β-estradiol. Compounds that stimulate GPER1 such as selective estrogen receptor modulators and phytoestrogens show neuroprotective activity and are alternatives to 17β-estradiol.
    Full-text · Article · Feb 2012 · Frontiers in Neuroendocrinology
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    • "Case reports have documented an increase in total and motor UPDRS scores during and after pregnancy (Shulman et al., 2000), with a faster symptom progression than that observed in the comparison cohort (Robottom et al., 2008). The substantial variations in estrogen levels during and after pregnancy were proposed to be implicated in the worsening of parkinsonian symptoms during these periods (Rubin, 2007; Robottom et al., 2008). An amelioration of PD symptoms and dyskinesia was reported to be present under conditions of estrogen therapy or high levels of endogenous estrogens (Villeneuve et al., 1978; Session et al., 1994; Giladi and Honigman, 1995). "
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    ABSTRACT: The existence of a sex difference in Parkinson's disease (PD) is observed as related to several variables, including susceptibility of the disease, age at onset, and symptoms. These differences between men and women represent a significant characteristic of PD, which suggest that estrogens may exert beneficial effects against the development and the progression of the disease. This paper reviews the neuroprotective and neuromodulator effects of 17β-estradiol and progesterone as compared to androgens in the nigrostriatal dopaminergic (NSDA) system of both female and male rodents. The 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mice model of PD and methamphetamine toxicity faithfully reproduce the sex differences of PD in that endogenous estrogen levels appear to influence the vulnerability to toxins targeting the NSDA system. Exogenous 17β-estradiol and/or progesterone treatments show neuroprotective properties against NSDA toxins while androgens fail to induce any beneficial effect. Sex steroid treatments show male and female differences in their neuroprotective action against methamphetamine toxicity. NSDA structure and function, as well as the distribution of estrogen receptors, show sex differences and may influence the susceptibility to the toxins and the response to sex steroids. Genomic and non-genomic actions of 17β-estradiol converge to promote survival factors and the presence of both estrogen receptors α and β are critical to 17β-estradiol neuroprotective action against MPTP toxicity.
    Full-text · Article · Sep 2011 · Frontiers in Endocrinology
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    • "She was diagnosed as having a spontaneous dichorionic/diamniotic twin pregnancy. To reduce the teratogenic risk of antiparkinsonian drugs [5], we eventually discontinued them except levodopa/carbidopa (450 mg/day) until the sixth week of gestation. Thereafter, her dyskinesia disappeared almost completely during the course of gestation. "
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    ABSTRACT: Pregnancy in patients with Parkinson disease is a rare occurrence. To the best of our knowledge, the effect of pregnancy as well as treatment in genetically confirmed autosomal recessive juvenile parkinsonism (ARJP) has never been reported. Here, we report the first case of pregnancy in a patient with ARJP associated with a parkin gene mutation, ARJP/PARK2. A 27-year-old woman with ARJP/PARK2 was diagnosed as having a spontaneous dichorionic/diamniotic twin pregnancy. Exacerbation of motor disability was noted between ovulation and menstruation before pregnancy as well as during late pregnancy, suggesting that her parkinsonism might have been influenced by fluctuations in the levels of endogenous sex hormones. During the organogenesis period, she was only treated with levodopa/carbidopa, although she continued to receive inpatient hospital care for assistance in the activities of daily living. After the organogenesis period, she was administered sufficient amounts of antiparkinsonian drugs. She delivered healthy male twins, and psychomotor development of both the babies was normal at the age of 2 years. Pregnancy may worsen the symptoms of ARJP/PARK2, although appropriate treatments with antiparkinsonian drugs and adequate assistance in the activities of daily living might enable successful pregnancy and birth of healthy children.
    Full-text · Article · Jun 2011 · BMC Neurology
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