Continuum: Lifelong Learning in Neurology—Neurology of Pregnancy, Volume 20, Issue 1, February 2014
Neurology of Pregnancy, February 2014;20(1)
Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.
Upon completion of the Continuum: Lifelong Learning in Neurology Neurology of Pregnancy issue, participants will be able to:
▸ Summarize safety concerns associated with diagnostic neuroimaging in women during pregnancy and lactation
▸ Discuss diagnostic modalities and radiologic features of neurologic conditions encountered by pregnant women
▸ Discuss the current understanding of the interactions between multiple sclerosis and pregnancy and their implications for reproductive counseling, and discuss the issues related to disease-modifying therapy and therapy of acute exacerbations of multiple sclerosis during pregnancy and lactation
▸ Explain issues regarding the management of women with epilepsy and pregnancy, including preconception planning, antiepileptic drug effects on the exposed offspring, and consequences of seizures during pregnancy, with an emphasis on counseling and risk management
▸ Identify the ways in which the physiologic changes of pregnancy affect risk of ischemic and hemorrhagic stroke, and discuss an approach to the diagnosis and treatment of ischemic and hemorrhagic stroke in pregnancy and the puerperium
▸ Outline the most common peripheral neuropathic disorders in pregnancy with a focus on clinical recognition, diagnosis, and treatment
▸ Analyze available information regarding expectations and management for patients with myasthenia gravis during childbearing years, pregnancy, and postpartum
▸ Diagnose and manage primary and secondary headaches that may occur during pregnancy and postpartum
▸ Describe movement disorders that occur during pregnancy, the treatment of preexisting movement disorders, and the influence the pregnant state has on movement disorder symptoms
▸ Evaluate and treat neuro-ophthalmic disorders in pregnant patients
▸ Summarize the available literature on reproductive issues in women with multiple sclerosis and provide sound, objective counseling to facilitate well-informed, autonomous decision making by patients
▸ Apply a practical framework for understanding, identifying, and managing legal risk when treating pregnant women with epilepsy
▸ Demonstrate the use of Current Procedural Terminology and diagnosis codes for the evaluation and management of neurologic disease in pregnant women, with a focus on those with epilepsy
The Continuum Neurology of Pregnancy issue covers the following core competencies:
▸ Patient Care
▸ Medical Knowledge
▸ Practice-Based Learning and Improvement
▸ Interpersonal and Communication Skills
▸ Systems-Based Practice
Autumn Klein, MD, PhD, Guest Editor†
Chief of the Division of Women’s Neurology, Assistant Professor of Neurology and Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Amaal AlDakheel, MD
Clinical Fellow, The Morton and Gloria Shulman Movement Disorders Centre in the Edmond J. Safra Program for Parkinson’s Disease, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
a,bDr AlDakheel reports no disclosures.
Riley M. Bove, MD
Instructor in Neurology, Harvard Medical School; Associate Neurologist, Brigham and Women’s Hospital, Boston, Massachusetts
a,bDr Bove reports no disclosures.
Patricia K. Coyle, MD, FAAN
Professor of Neurology and Vice Chair (Clinical Affairs); Director, Stony Brook MS Comprehensive Care Center, Stony Brook University, Stony Brook, New York
aDr Coyle has consulted for Acorda Therapeutics; Accordant Health Services; Bayer AG; Biogen Idec; Genentech, Inc; Genzyme Corporation; Merck KGaA; Mylan Inc; Novartis Corporation; and Teva Pharmaceuticals. Dr Coyle receives clinical trial support from Actelion Pharmaceuticals; Novartis Corporation; and Opexa Therapeutics, Inc.
bDr Coyle discusses the unlabeled use of IV immunoglobulin post partum.
Carolina De Jesus-Acosta, MD
Fellow, Neuromuscular Medicine, Duke University Medical Center, Durham, North Carolina
aDr De Jesus-Acosta reports no disclosure.
bDr De Jesus-Acosta discusses the use of drugs for the treatment of myasthenia gravis, none of which are labeled by the US Food and Drug Administration for use in pregnancy.
Kathleen B. Digre, MD, FAAN
Professor, Departments of Neurology of Ophthalmology; Adjunct Professor, Department of Obstetrics and Gynecology, Moran Eye Center, University of Utah
aDr Digre has received a grant from the National Eye Institute and salary support from the Neuro-ophthalmology Research Disease Investigator Consortium.
bDr Digre discusses the use of several drugs for the treatment of neuro-ophthalmic disorders, none of which are labeled by the US Food and Drug Administration for use in pregnancy.
Steven K. Feske, MD
Associate Professor of Neurology, Harvard Medical School; Director, Stroke Division, Brigham and Women’s Hospital, Boston, Massachusetts
aDr Feske has received royalties from Elsevier for his role as editor of Office Practice of Neurology, 2nd Edition, and receives research support from the National Institute of Neurological Disorders and Stroke.
bDr Feske reports no disclosure.
Amanda C. Guidon, MD
Instructor of Neurology, Harvard Medical School; Assistant in Neurology, Massachusetts General Hospital, Boston, Massachusetts
a,bDr Guidon reports no disclosures.
Cynthia L. Harden, MD
Professor of Neurology; Chief, Division of Epilepsy and Electroencephalography, Hofstra North Shore—LIJ School of Medicine, Great Neck, New York
aDr Harden has received personal compensation for activities with GlaxoSmithKline; Lundbeck; UCB SA; and Upsher-Smith Laboratories, Inc. Dr Harden has served in an editorial capacity for UpToDate and received research support from the Epilepsy Therapy Project.
bDr Harden reports no disclosure.
Joseph S. Kass, MD, JD
Associate Professor of Neurology, Psychiatry, and Medical Ethics, Baylor College of Medicine, Houston, Texas
a,bDr Kass reports no disclosures.
Krista Kinard, MD
Instructor, Department of Ophthalmology, Moran Eye Center, University of Utah
aDr Kinard reports no disclosure.
bDr Kinard discusses the use of several drugs for the treatment of neuro-ophthalmic disorders, none of which are labeled by the US Food and Drug Administration for use in pregnancy.
Joshua P. Klein, MD, PhD
Chief, Division of Hospital Neurology, Brigham and Women’s Hospital; Assistant Professor of Neurology and Radiology, Harvard Medical School, Boston, Massachusetts
aDr Klein receives financial compensation for serving on the editorial board of the Journal of Neuroimaging and AccessMedicine Neurology, and royalties from McGraw-Hill for Adams and Victor’s Principles of Neurology.
bDr Klein reports no disclosure.
E. Anne MacGregor, MB BS, MD, FFSRH, MICR
Associate Specialist, Barts Sexual Health Centre, St Bartholomew’s Hospital; Honorary Professor, Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, England, United Kingdom
aProfessor MacGregor has acted as a paid consultant to and/or her department has received research funding from Addex Therapeutics; Allergan, Inc; AstraZeneca; Berlin-Chemie AG; BTG International Ltd; Endo Pharmaceuticals Inc; GlaxoSmithKline; the Menarini Group; Merck & Co, Inc; POZEN Inc; and UniPath.
bProfessor MacGregor discusses the use of several drugs for the treatment of headaches, none of which are labeled by the US Food and Drug Administration for use in pregnancy.
E. Wayne Massey, MD, FAAN
Professor, Department of Neurology, Duke University Medical Center, Durham, North Carolina
a,bDr Massey reports no disclosures.
Janice M. Massey, MD, FAAN
Professor, Department of Neurology; Chief, Neuromuscular Division, Duke University Medical Center, Durham, North Carolina
aDr Massey has received educational grants from Allergan, Inc; and Merz Pharma.
bDr Massey discusses the use of drugs for the treatment of myasthenia gravis, none of which are labeled by the US Food and Drug Administration for use in pregnancy.
Janis M. Miyasaki, MD, MEd, FRCP, FAAN
Associate Professor, Department of Medicine, and Associate Clinical Director, The Movement Disorders Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, Ontario; Associate Professor, Neurology, University of Alberta, Edmonton, Alberta, Canada
aDr Miyasaki has served as a speaker or on advisory boards for Novartis Corporation and Teva Pharmaceuticals. Dr Miyasaki has received research support from the Canadian Agency for Drugs and Technologies in Health, the Canadian Institute for Health Research, the Michael J. Fox Foundation for Parkinson’s Research, the National Center for Complementary and Alternative Medicine, the National Parkinson Foundation, the NIH, the Ontario Drug Benefits Program, and the Ontario Ministry of Health and Long-Term Care. The Movement Disorders Centre at Toronto Western Hospital has received research support from Teva Pharmaceuticals Ltd.
bDr Miyasaki reports no disclosure.
Bethanie N. Morgan-Followell, MD
Assistant Professor of Pediatrics, Section of Child Neurology, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
aDr Morgan-Followell reports no disclosure.
bDr Morgan-Followell discusses the unlabeled use of disease-modifying therapies during attempts at conception and during pregnancy.
Jacqueline A. Nicholas, MD, MPH
Assistant Professor of Neurology, Division of Neuroimmunology, The Ohio State University Medical Center, Columbus, Ohio
aDr Nicholas’ fellowship is funded through a Sylvia Lawry Physician Fellowship grant from the National Multiple Sclerosis Society, and she receives additional funding for clinical research from the National Multiple Sclerosis Society as an assistant professor.
bDr Nicholas discusses the unlabeled use of disease-modifying therapies during attempts at conception and during pregnancy.
Laura B. Powers, MD, FAAN
Dr Powers is retired from private practice.
aDr Powers serves as ICD-9-CM Advisor for the Coding Subcommittee of the AAN Medical Economics and Management Committee and serves in an editorial capacity for Neurology: Clinical Practice.
bDr Powers reports no disclosure.
Aneesh B. Singhal, MD
Associate Professor of Neurology, Harvard Medical School; Director, Neurology Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts
aDr Singhal has served as a consultant for Biogen Idec and as a medical expert witness in cases of stroke. Dr Singhal’s spouse holds stock or stock options greater than 5% of the company or greater than $10,000 in value in Biogen Idec, and Vertex Pharmaceuticals Incorporated. Dr Singhal has received research support from the National Institute of Neurological Disorders and Stroke, and his institution has received research support from Pfizer Inc and PhotoThera, Inc, for clinical trial participation.
bDr Singhal reports no disclosure.
Pedro Weisleder, MD, PhD
Professor, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
aDr Weisleder serves as a consultant for the Medical Review Institute of America and as associate editor of the Journal of Child Neurology.
bDr Weisleder discusses the unlabeled use of disease-modifying therapies during attempts at conception and during pregnancy.
Mark S. Yerby, MD, MPH, FAAN
Founder, North Pacific Epilepsy Research; Chair, Scientific Advisory Board, North American Epilepsy and Pregnancy Registry; Associate Clinical Professor of Neurology and Public Health, Oregon Health & Science University, Portland, Oregon
aDr Yerby serves on the speakers bureaus for Lundbeck and Supernus Pharmaceuticals, Inc.
bDr Yerby reports no disclosure.
Eduardo E. Benarroch, MD, DSci, FAAN
Professor of Neurology, Mayo Clinic, Rochester, Minnesota
aDr Benarroch has received personal compensation in an editorial capacity for Neurology.
bDr Benarroch reports no disclosure.
Ronnie Bergen, MD
Assistant Professor of Clinical Neurology, University of Arizona College of Medicine, Tucson, Arizona; Staff Neurologist, Southern Arizona VA Healthcare System, Tucson, Arizona
a,bDr Bergen reports no disclosures.
bUnlabeled Use of Products/Investigational Use Disclosure
†Died April 20, 2013
Methods of Participation and Instructions for Use
Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.
The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.
Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive CME and self-assessment offerings, including a self-assessment pretest, postreading CME test questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.
The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Video material relating to the issue topic accompanies issues when applicable.
The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.