Successful twin pregnancy in a patient with parkin-associated autosomal recessive juvenile parkinsonism

A 27-year-old woman with ARJP/PARK2 was diagnosed as having a spontaneous dichorionic/diamniotic twin pregnancy. Exacerbation of motor disability was noted between ovulation and menstruation before pregnancy as well as during late pregnancy, suggesting that her parkinsonism might have been influenced by fluctuations in the levels of endogenous sex hormones. During the organogenesis period, she was only treated with levodopa/carbidopa, although she continued to receive inpatient hospital care for assistance in the activities of daily living. After the organogenesis period, she was administered sufficient amounts of antiparkinsonian drugs. She delivered healthy male twins, and psychomotor development of both the babies was normal at the age of 2 years.Pregnancy may worsen the symptoms of ARJP/PARK2, although appropriate treatments with antiparkinsonian drugs and adequate assistance in the activities of daily living might enable successful pregnancy and birth of healthy children.Pregnancy in patients with Parkinson disease (PD) is a rare occurrence. However, physicians treating pregnant patients with PD should be aware of the impact of pregnancy on parkinsonism as well as that of the treatment for PD on pregnancy and fetal development [1,2]. To the best of our knowledge, the effect of pregnancy in genetically-confirmed autosomal recessive juvenile parkinsonism (ARJP) has never been reported. Here, we report the first case of pregnancy in a patient with ARJP associated with a parkin gene mutation (ARJP/PARK2), which is characterized by early onset, marked response to levodopa treatment, and levodopa-induced dyskinesia [3].A 27-year-old woman with ARJP having heterozygous exonic deletion mutations (Δexon 4/Δexons 2-4) of the parkin gene (patient II-2 in pedigree 455) [4] was referred to our hospital at the fifth week of gestation. This patient showed bradykinesia, rigidity, postural instability, dystonia, a slowly progressive course, and alleviation of symptoms in respon