Gebelikte Nörolojik Hastalıklar
Özet
Gebelikte en sık karşılaşılan nörolojik rahatsızlıklar hamilelik öncesiyle benzerlik gösterse de, bu süreç hastalıkların yönetimi üzerinde zorlayıcı etkiler yaratabilmektedir. Kadınlarda daha sık görülen primer baş ağrılarından gerilim tipi gebelikte değişmezken, migren özellikle ikinci ve üçüncü trimesterde yüksek östrojen seviyelerinin koruyucu etkisiyle çoğunlukla iyileşme gösterir. Epilepsili gebelerde nöbet kontrolünün sağlanması maternal ve fetal morbiditeyi önlemek adına hayati önem taşır; antiepileptik ilaçlardan valproat en yüksek malformasyon riskine sahipken lamotrijin ve levetirasetam gibi ilaçların anomali riski düşüktür. Kronik bir hastalık olan multipl sklerozun aktivitesi gebelikte azalırken, postpartum dönemde artış gösterir. Miyastenia gravis ise solunum yetmezliğine yol açabilen miyastenik kriz gibi riskler barındırır ve magnezyum sülfat kullanımı bu hastalarda kontrendikedir. Periferik sinir tutulumlarından fasyal paralizi (Bell paralizisi) son trimesterde ve lohusalıkta dört kat daha sık görülürken, karpal tünel sendromu en sık üçüncü trimesterde bilateral olarak karşımıza çıkar. Hemorajik ve iskemik serebrovasküler hastalıklar ile inme riskleri özellikle gebeliğin son dönemleri ve postpartum süreçte belirgin artış göstermekte, bu durumların büyük bir kısmı ise preeklampsi-eklampsi tablosuna bağlanmaktadır.
The most common neurological disorders during pregnancy are similar to those before pregnancy, yet this period poses challenges for disease management. While tension-type headache, a primary headache more common in women, remains unchanged during pregnancy, migraine typically improves especially in the second and third trimesters due to the protective effect of high estrogen levels. In pregnant patients with epilepsy, maintaining seizure control is critical to prevent maternal and fetal morbidity; among antiepileptic drugs, valproate carries the highest risk of malformation, whereas lamotrigine and levetiracetam have low anomaly risks. The activity of multiple sclerosis, a chronic disease, decreases during pregnancy but increases in the postpartum period. Myasthenia gravis carries risks such as myasthenic crisis that can lead to respiratory failure, and the use of magnesium sulfate is contraindicated in these patients. Regarding peripheral nerve involvements, facial paralysis (Bell's palsy) is observed four times more frequently in the last trimester and postpartum, while carpal tunnel syndrome occurs most commonly in the third trimester bilaterally. The risks of hemorrhagic and ischemic cerebrovascular diseases and stroke increase significantly during late pregnancy and the postpartum period, with a large portion of these cases being attributed to preeclampsia-eclampsia.
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