Pregnancy and Anesthesia in Narcolepsy

Abstract

The management of pregnancy in patients with narcolepsy involves issues regarding the risk to the mother and fetus related to the disease, potential risks at the time of conception and the risk to both the mother and fetus of the medications used to treat narcolepsy, and the risk to the infant from medications that might be secreted in breast milk. In addition there is a question of whether a patient with narcolepsy can safely undergo anesthesia.

As there are no practice parameters on the treatment of narcolepsy patients during pregnancy, the management of patients with narcolepsy varies greatly from clinician to clinician and from country to country. Most clinicians advise stopping narcolepsy medications at the time of conception, during pregnancy, and during breastfeeding, but some reduce the dose and others do not change the dosage, depending upon the particular medication in question. The question of whether the patient should have anesthesia and caesarian section often arises.

The perceived risks of narcolepsy medication during pregnancy to the mother and fetus are usually overestimated, as the risk of teratogenic effects from narcolepsy medications in therapeutic doses is essentially nonexistent. However, the potential for rare complications during pregnancy and congenital abnormalities cannot be excluded. Most narcolepsy patients will have vaginal delivery without complications, but some patients have cataplexy that interferes with delivery and caesarian may be required; however, there appears to be no increased anesthetic or surgical risks.