This is a case report by Washington University (St. Louis) clinicians of a 31-year-old Irish woman who lived in the midwest US with parkinsonism, initially diagnosed with Parkinson’s Disease. She had a baby at age 35. “Her pregnancy was complicated by severe orthostatic hypotension and motor fluctuations.” At age 37, she had DBS (deep brain stimulation). She died eight years after disease onset. Upon brain autopsy, it was found she had multiple system atrophy (MSA). The authors conclude that “pregnancy may be associated with marked disease progression.”
I don’t know if the authors considered that the DBS may’ve been associated with “marked disease progression.” If anyone looks, let me know!
I’ve copied the abstract below. The full article is available at no charge online.
Also, this must be one of the youngest documentated cases of MSA.
Robin
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www.jmedicalcasereports.com/content/pdf/1752-1947-5-599.pdf –> full article is available here at no charge
Journal of Medical Case Reports. 2011 Dec 30;5(1):599. [Epub ahead of print]
Pregnancy in multiple system atrophy: a case report.
Zhu L, Cairns NJ, Tabbal SD, Racette BA.
Abstract
INTRODUCTION:
Multiple system atrophy is a late, adult-onset alpha-synucleinopathy with no data on the effect of pregnancy on the disease course. Early stage multiple system atrophy can be difficult to distinguish from Parkinson’s disease.
CASE PRESENTATION:
We describe the case of an Irish woman with parkinsonism starting at age 31, initially diagnosed as having dopa-responsive, idiopathic Parkinson’s disease, who successfully delivered a full-term child at age 35. Her pregnancy was complicated by severe orthostatic hypotension and motor fluctuations. Two years post-partum, she underwent bilateral subthalamic nuclei deep brain stimulation for intractable motor fluctuations and disabling dyskinesia. After this treatment course she experienced deterioration of motor symptoms and death eight years after disease onset. Post-mortem neuropathological examination revealed striatonigral degeneration and alpha-synuclein-positive glial cytoplasmic inclusions in brain stem nuclei, basal ganglia and white matter tracts, consistent with a neuropathological diagnosis of multiple system atrophy.
CONCLUSIONS:
Multiple system atrophy can affect women of child-bearing age and pregnancy may be associated with marked disease progression.
PubMed ID#: 22208291 (see pubmed.gov for the abstract only)