Pregnancy and delivery in tetraplegic women.

Increase in survival of spinal cord injured (SCI) women, society's acceptance that their lives should be similar to those of non-disabled women and their better general health are increasing the number of SCI women who become pregnant and will be delivered of a child. Vaginal delivery is preferred. Any SCI woman whose level is at T6 or higher is at risk for acute autonomic hyperreflexia as a result of uterine contractions. If induction is with Pitocin/Oxytocin, the risk is even greater. Communication with the woman's obstetrician is essential. The patient should be provided with a packet of information to share with the obstetrician. This should be followed with a phone call from the SCI physician to the obstetrician. Effective management includes epidural anesthesia; vacuum extraction is helpful in the expulsion stage. Episiotomy is usually not needed since the pelvic floor is relaxed. In addition, there is an increased incidence of dehiscence since SCI women should be mobilized early and need to transfer in and out of a wheelchair. Blood pressure needs to be taken during the peak of contraction. This needs to be compared to prenatal blood pressures. If prenatal blood pressure is 80/60 or 90/60 but during contraction is 130/80 with a pounding headache, that indicates autonomic hyperreflexia which is an indication for epidural anesthesia. With improvement of acute care and more effective rehabilitation, pregnancy and delivery in spinal cord injured (SCI) women will occur more frequently. No one has any great experience with this situation and most articles report only a few cases. Even the report by Goller and Paeslack4 dealt with 175 cases from 42 centers in 24 countries. Most women were paraplegic and several who were injured early in their pregnancy had abnormal babies (possibly due to x-rays taken for spinal injury). Our spinal cord injury staff were pleased when we had two tetraplegic patients who were pregnant. It helped confirm our belief that life and its functions continue after paralysis. Staff members were involved in prenatal care, were present during delivery and were involved with postnatal care. Even more important is the fact that rehabilitation from the start was oriented with child care in mind. Occupational therapists used their skills and imagination to develop a program for newborn baby care by the tetraplegic mother.

Episodic symptoms in dysfunctioning children and adolescents following mild and severe traumatic brain injury.

The present investigation examines the phenomenology of episodic symptoms in dysfunctioning children and adolescents following mild (n = 25) or severe (n = 25) traumatic brain injury (TBI). TBI patients in both groups commonly endorsed symptoms such as staring spells, memory gaps, and temper outbursts. Anticonvulsant response in the 27 patients treated, reflected moderate to substantial improvement in 92%. A dose-response relationship between injury severity and number of episodic symptoms was not observed; however, patients in the severe TBI sample did produce significantly more defective performances on a dichotic word-listening task (DWLT) and lower IQ values. Defective DWLT performance was also significantly associated with greater number of episodic symptoms endorsed, but only in the mild TBI sample. Parallels with epilepsy spectrum disorder and clinical implications for paediatric TBI are discussed.

Multiple partial seizure-like symptoms following 'minor' closed head injury.

This report is a phenomenological study of 17 patients who developed multiple, partial seizure-like symptoms after sustaining relatively 'minor' closed head trauma. Unlike patients with classic complex partial seizure disorders, the symptoms of these head-injured patients did not tend to occur in stereotyped sequences. In contrast to meagre findings from neuroimaging and EEG evaluations, neuropsychological assessment of these patients often revealed evidence of static and episodic cognitive impairment. The majority of patients in this case series derived significant benefit from treatment with anticonvulsant medication; however, full return to premorbid levels of social and vocational competence was not typically observed. Recent findings from animal research on 'partial kindling' phenomena provide a hypothetical model for understanding how subclinical electrophysiological dysfunction may produce partial seizure-like symptoms and associated neurobehavioural dysfunction as longer-term sequelae of traumatic brain injury.

Spinal cord injured women, pregnancy and delivery.

The author presents a review of his personal experience, a patient survey and literature review on 33 spinal cord injured women, who had a total of 50 deliveries.