Neurology and Neurosurgery

Referral criteria

Neurological conditions for consideration of referral for an opinion, advice or MMC led care.

For women requiring MMC led care they are managed in the maternal medicine Antenatal clinic that runs on Monday mornings at the RVI. Please see appendix x for the regional epilepsy referral pathway.

Lead Maternal Medicine Obstetrician- Dr M Pearce

Lead Obstetric Physician- Dr K Cranfield

Lead Neurologist- Dr E Akay

Epilepsy Specialist Nurse- NUTH/Northumbria/Gateshead- G Clark

Epilepsy Specialist Nurse- Sunderland-

Epilepsy Specialist Nurse- Cumbria & Whitehaven-

Epilepsy Specialist Nurse- JCUH (?encompases Darlington/NT/Durham?)

Clinical Resources

Epilepsy

Epilepsy in Pregnancy (Green Top Guideline) Epilepsy in Pregnancy (Green-top Guideline No. 68) | RCOG

240605-NENC-Epilepsy-and-Pregnancy-Guideline-FINAL.pdf

Myasthenia Gravis

Drugs to Avoid | myaware

Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group | Journal of Neurology, Neurosurgery & Psychiatry

Multiple Sclerosis

UK Consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines | Practical Neurology

Patient Resources

Epilepsy

Epilepsy action https://www.epilepsy.org.uk/living/starting-a-family/pregnancy-birth-and-epilepsy
Epilepsy action- Labour, birth and after the baby is born Giving Birth with Epilepsy – Epilepsy Action

Epilepsy society https://epilepsysociety.org.uk/living-epilepsy/starting-a-family (safety info)
UK Epilepsy & Pregnancy Register https://www.epilepsyandpregnancy.co.uk
Epilepsy medicines and pregnancy Epilepsy medicines and pregnancy – Epilepsy Action

Migraine

Migraine in Pregnancy- Migraine in pregnancy – The Migraine Trust

Treatment of Migraine in pregnancy – Bumps website- Migraine

Myasthenia Gravis

Myasthenia Gravis and pregnancy- Myasthenia gravis and Pregnancy, can you get pregnant with myasthenia gravis, congenital myasthenia syndrome, birth

Multiple Sclerosis

Pregnancy and MS– Pregnancy and MS | MS Trust

MS Decisions– MS Decisions | MS Trust

Category A Local expertise	Category B Review, advice and guidance from maternal medicine centre	Category C Care led by maternal medicine centre
Epilepsy managed in a combined clinic including specialist neurology and obstetrics Migraine Stable, small cerebrovascular malformation, reviewed within 2 years of conception, plan for mode of delivery Previous brain tumour Previous cerebral vein thrombosis Meningitis Previous encephalitis Stable multiple sclerosis managed without disease modifying drugs Mononeuropathy e.g. Bell’s palsy carpal tunnel, peroneal nerve compression Post-dural puncture headache	Cluster headache Idiopathic intracranial hypertension Cerebrovascular malformation, not reviewed within 2 years of conception Current brain tumour New cerebral vein thrombosis Previous Guillain Barre Syndrome Treated, stable myasthenia gravis Unstable multiple sclerosis or disease modifying drugs Progressive or persistent mononeuropathy New encephalitis Reversible Cerebral Vasoconstriction syndrome Posterior reversible encephalopathy Spinal cord injury Neurofibromatosis Neuromuscular dystrophy Spinal muscular atrophy Motor neurone disease	All epilepsy without local access to a combined clinic including specialist neurology and obstetrics Symptomatic raised intracranial pressure Unstable CVM/AVM/cavernoma intracerebral bleed within 2 years Progressive brain tumour Acute stroke New-onset Guillain-Barre syndrome New diagnosis or flare of myasthenia gravis Myotonic dystrophy