Is DBS safe during pregnancy?

By Anna Shavers

Deep brain stimulation (DBS) can provide symptom relief for people living with neurologic or psychiatric conditions, but is DBS safe during pregnancy?

Max Parker (left), Caroline King (right)
Max Parker (left), Caroline King (right)

Max Parker and Caroline King, fourth year medical students at the University of Florida College of Medicine, completed a comprehensive review of publications and clinical trials and interviewed experts to understand the benefits and risks of DBS during pregnancy.

“While clear guidance is not available on the safety of DBS during pregnancy, there are case reports of patients who did decide to continue their [DBS] therapy. These patients appeared to have no difficulty conceiving and had no serious adverse outcomes in the pregnancy or postpartum periods specifically related to the DBS system,” said co-author, Max Parker.

Deep brain stimulation sends electric shocks in timed intervals to targeted areas of the brain to manage symptoms such as tremor, mood shifts and other symptoms in patients. As of 2018, the U.S. Food and Drug Administration has approved DBS for dystonia, severe epilepsy, essential tremor, severe obsessive-compulsive disorder and Parkinson’s disease. 

Clinical trials are actively taking place to assess the risks and benefits of DBS for additional conditions that may impact the lives of younger people more frequently such as anxiety, depression, Tourette syndrome and other conditions.

“We found the clinical trials offering cutting-edge DBS for conditions that affect young patients routinely exclude pregnant patients,” said Parker.

Research has shown that many of the conditions being studied for DBS can have serious adverse effects on a pregnant person and fetus, especially when the condition requires medications that may cause harm during pregnancy.

“Pregnant and lactating individuals should be considered for inclusion in prospective trials of DBS in order to generate the highest quality evidence on DBS effectiveness in these populations,” said John Smulian, M.D., M.P.H., supporting author and chair and professor of OBGYN at UF Health and the Center for Perinatal Outcomes Research.

Researchers and clinicians agree that additional research is needed to understand how DBS can be applied safely in pregnancy.

“While this review only scratches the surface and is the first step in bringing attention to DBS and pregnancy, we encourage more data reporting regarding DBS in patients who are pregnant or planning to conceive,” said Parker.

The comprehensive review was completed under the mentorship of Joshua Wong, M.D., assistant professor of neurology at the Norman Fixel Institute for Neurological Diseases at UF Health, with the following team of authors: Michael Okun, M.D., chair and professor of neurology and executive director of the Norman Fixel Institute for Neurological Diseases at UF Health; Kay Roussos-Ross, M.D., professor of OBGYN and psychiatry at UF Health; and Adolfo Ramirez-Zamora, M.D., associate professor of neurology and program director and division chief of movement disorders at the Norman Fixel Institute for Neurological Diseases at UF Health.

Read the review in Frontiers in Human Neuroscience.