Multidisciplinary perinatal management of paroxysmal kinesigenic dyskinesia in pregnancy: a case report and a proposed structured pathway.

Background: Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder characterized by brief dystonic or dyskinetic attacks precipitated by sudden voluntary movement or arousal. Pregnancy complicated by PKD is extremely rare, and evidence guiding perinatal decision-making, especially regarding delivery mode and anesthetic management remains scarce. Case presentation: We report a term pregnancy in a woman with long-standing PKD managed through a multidisciplinary team involving neurology, obstetrics, anesthesiology, and neonatology. Following individualized optimization of antiseizure medications (ASMs) and intensive antenatal surveillance, the patient showed moderate symptomatic improvement during pregnancy. Given the high risk of pain, stress, or movement-triggered dystonic attacks with transient loss of voluntary motor control during labor, elective cesarean delivery was planned. Combined spinal-epidural anesthesia (CSEA) was performed to provide effective analgesia while minimizing arousal and sensory triggers. The procedure was uneventful, with no perioperative dystonic episodes. A healthy neonate was delivered with no congenital anomalies. Conclusion: This case demonstrates that favorable maternal and neonatal outcomes can be achieved in pregnancies complicated by PKD through individualized antiseizure medication management, multidisciplinary care, and trigger-oriented perinatal planning. The structured clinical decision-making pathway proposed in this study may provide a practical framework for managing this rare and challenging condition.