Editor’s Preface

The Neurology of Pregnancy: A Tribute to Dr Autumn Klein

* 2014, American Academy of Neurology.

cians who care for womThis issue of This issue of en with seizure disorders is dedicated to the memory of who are of childbearing Dr Autumn Klein, whose toois age will benefit from the short career was devoted to the dedicated to the very practical, thorough, care of pregnant women with memory of and up-to-date analysis neurologic disease and to the she provides to guide education of neurologistsVand Dr Autumn Klein, other physicians who care for who was devoted to us in our management of these patients. women of childbearing ageV the care of pregnant Drs Steven Feske and about these critically important Aneesh Singhal discuss and complex neurologic issues women with the cerebrovascular disorthat can impact both the mothneurologic disease ders that may complicate er and her child. As the guest editor of this issue, Dr Klein and to the education pregnancy. In this article, carefully planned and organized of neurologists about the authors thoroughly review ischemic and these topics and invited this these critically hemorrhagic strokes that group of expert authors to inimportant and may be associated with form us about the current and pregnancy and provide optimal diagnosis and managecomplex issues. us with an expert discusment of the variety of neurologic sion of preeclampsia/ disorders that can affect women during pregnancy and the postpartum period. eclampsia, the posterior reversible encephaThe issue begins with an overview by lopathy syndrome (PRES), and the reversible Drs Riley Bove and Joshua Klein of the cerebral vasoconstriction syndrome (RCVS); considerations involved in the neuroradio- their state-of-the-art review will help us logic investigation of women who are recognize and manage these overlapping pregnant or breast-feeding. This article pro- syndromes. Next, Drs E. Wayne Massey and vides an important introduction to the Amanda Guidon review the diagnosis and diagnostic issues involved in nearly all of management of peripheral neuropathies in the subsequent articles with regard to the pregnancy. These authors provide a thorough risks and benefits of the various imaging discussion of the diagnosis and management modalities available to us and their current of the variety of cranial neuropathies, role in our diagnostic armamentarium in radiculopathies, mononeuropathies, and these settings. Next, Dr Patricia Coyle polyneuropathies that can occur coincident discusses multiple sclerosis in pregnancy with, or as a consequence of, pregnancy or and the postpartum state, an issue that we delivery. The next article, by Drs Janice deal with frequently given the prevalence of Massey and Carolina De Jesus-Acosta, is multiple sclerosis in women of childbearing devoted to the specific neuromuscular disease age. This comprehensive review will provide of myasthenia gravis, which may complicateV readers with a very current understanding of or even occasionally present inVpregnancy. the issues regarding risk of relapse and We will benefit from their expertise, which current recommendations regarding the we can emulate as we counsel and manage role, or lack thereof, of acute and preventive our patients with this potentially life-threatentherapy in these settings. Dr Cynthia Harden ing, but treatable, neuromuscular disease. Dr E. Anne MacGregor provides her then discusses the commonly encountered issue of epilepsy and pregnancy. All clini- expertise to help us counsel and manage Continuum (Minneap Minn) 2014;20(1):21–22

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Editor’s Preface

our pregnant patients with primary headache disorders, as well as to recognize and manage those secondary headache disordersVsome of which may carry significant morbidity and mortality if not recognized and treated expeditiouslyVthat may occur in association with (and in some cases as a consequence of) pregnancy or the postpartum state. Drs Janis Miyasaki and Amaal AlDakheel discuss the movement disorders that may occur in pregnant women. In their thorough review, these authors provide their approach to the counseling, diagnosis, and management of patients whose movement disorders may specifically arise during pregnancy (such as restless legs syndrome and chorea gravidarum), as well as to the many management issues that arise among patients with preexisting movement disorders who become pregnant. In the final review article of this issue, Drs Kathleen Digre and Krista Kinard review neuroophthalmic disorders that may occur in association with pregnancy. These authors provide us with their very practical symptomand finding-based approach to the diagnosis and management of the neuro-ophthalmic disorders that can affect vision and eye movements, whether caused by, or just coincident with, pregnancy. In this issue’s Ethical Perspectives section, Drs Bethanie Morgan-Followell, Jacqueline Nicholas, and Pedro Weisleder carefully analyze the complex ethical considerations involved in the counseling of a postpartum breast-feeding woman with multiple sclerosis in regard to the timing of restarting disease-modifying therapy. In the Practice section, Dr Joseph Kass shares his neurologic and legal expertise by providing practical case examples involving epilepsy and pregnancy to illustrate several issues involved in mitigating legal risk as we provide our highest level of care to pregnant patients with neurologic disease. Finally, Drs Mark Yerby and Laura Powers outline the issues involved in coding of the pregnant patient with neurologic disease, including a focus on specific considerations related to coding of the pregnant patient with epilepsy. issue, a As with every number of opportunities exist for CME. If

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you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment, submit your answers to the multiple-choice questions in the Self-Assessment Pretest crafted by Drs Eduardo Benarroch and Ronnie Bergen before you read the issue; review your results to better tailor your learning needs; and then complete the Postreading CME Test after reading the issue. By doing so you may earn up to 12 AMA PRA Category 1 CME CreditsTM toward self-assessment. Alternatively, you may wish to receive credits toward CME only, in which case, reading the issue and submitting the Postreading CME Test will allow you to earn up to 10 AMA PRA Category 1 CME Credits. The Patient Management Problem, written by Dr Riley Bove, involves the management of a woman presenting to the emergency department with neurologic symptoms in her third trimester of pregnancy. By following her case and answering multiplechoice questions corresponding to important diagnostic and therapeutic decision points along the rest of her pregnancy and delivery (reinforcing many of the issues discussed in the previous articles), you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits. I would like to give my special and sincere gratitude to Drs Steven Feske and Riley Bove, who provided their valuable time and considerable expertise in assisting in the editing of this issue and in bringing Dr Klein’s volume to fruition after her passing. My special thanks also to each of the contributors to this issue, who accepted Dr Klein’s invitation to impart their expertise to our readers and whose outstanding contributions serve as a lasting tribute to her memory. All of us on the editorial staff of are honored to have been able to work with Dr Klein during the planning and creation of this issue, through which each of us and our patients can continue to benefit from the knowledge and dedication of this remarkable physician.

VSteven L. Lewis, MD, FAAN Editor-in-Chief

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Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

February 2014

The neurology of pregnancy: a tribute to dr autumn klein. Preface.

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