1
|
Post-partum relapse in women with multiple sclerosis after neuraxial labour analgesia or neuraxial anaesthesia: A multicentre retrospective cohort study. Anaesth Crit Care Pain Med 2021; 40:100834. [PMID: 33753296 DOI: 10.1016/j.accpm.2021.100834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/01/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The proportion of women with multiple sclerosis experiencing a relapse in the post-partum period after neuraxial labour analgesia or neuraxial anaesthesia remains uncertain. This study aimed to assess the association between neuraxial labour analgesia or neuraxial anaesthesia and the occurrence of relapse during the first three months post-partum. METHODS In this retrospective cohort study, cases of women with a diagnosis of multiple sclerosis delivering between January 2010 and April 2015 were analysed. Demographic, anaesthetic and obstetric characteristics, occurrence and number of relapses in the year preceding pregnancy, during pregnancy, and the first three post-partum months, were recorded. Logistic regression analyses were performed for the identification of factors associated with the occurrence of post-partum relapse. RESULTS A total of 118 deliveries in 104 parturients were included, these were 78 (66%) vaginal deliveries and 40 (34%) caesarean deliveries. Neuraxial analgesia was provided in 50 deliveries, and neuraxial anaesthesia in 46 deliveries; no neuraxial anaesthesia or analgesia was administered in remaining 22 deliveries. Post-partum relapse occurred in 31 women (26%). There was no association between obstetric or anaesthetic characteristics and post-partum relapse. Both the occurrence and number of relapses prior to and during pregnancy, and the time between last relapse and delivery, were significantly associated with post-partum relapse in univariate analysis. The occurrence of relapse within the year preceding the pregnancy was the sole independent factor associated with post-partum relapse. CONCLUSION Neuraxial procedures were not associated with increased rate of post-partum relapse; only disease activity prior to pregnancy was predictive of post-partum relapse.
Collapse
|
2
|
Vukusic S, Michel L, Leguy S, Lebrun-Frenay C. Pregnancy with multiple sclerosis. Rev Neurol (Paris) 2020; 177:180-194. [PMID: 32736812 DOI: 10.1016/j.neurol.2020.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is usually diagnosed between twenty and forty years of age, when people often plan to have children. A lot has been said about the effect of pregnancy on the course of MS. The individual factors responsible for the disease modifying effect of pregnancy are not well determined. Having MS neither affects the fertility or the course of pregnancy itself. During pregnancy, many women find that their symptoms stay the same or even improve. Epidural and spinal analgesia appear to be safe and in general are not contraindicated for patients with MS. The management of disease-modifying treatments (DMTs) in pregnancy is a new issue for consideration in the clinical practice. There is limited information available into the safety of DMT use during pregnancy, especially for the most recent ones. In general, discontinuation of DMTs is recommended before conception to minimize risk of fetal harm. Women with very active MS before pregnancy who stop second-line treatments may show an increase in disease activity during pregnancy. Therefore, it might be discussed to maintain patients on DMTs until pregnancy is confirmed, and sometimes throughout pregnancy, to avoid a rebound of disease activity and severe relapses during pregnancy in very active patients.
Collapse
Affiliation(s)
- S Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation et centre de recherche, ressources et compétences sur la sclérose en plaques, hospices civils de Lyon, 69677 Bron, France; Inserm 1028 et CNRS UMR 5292, observatoire français de la sclérose en plaques, centre de recherche en neurosciences de Lyon, 69003 Lyon, France; Université de Lyon, université Claude-Bernard Lyon 1, 69000 Lyon, France; Eugène Devic EDMUS Foundation against multiple sclerosis, state-approved foundation, 69677 Bron, France
| | - L Michel
- Inserm, CIC 1414 [(centre d'investigation clinique de Rennes)], neurology, université Rennes, CHU Rennes, 35000 Rennes, France; Inserm, établissement français du sang, unité mixte de recherche (UMR) S1236, university of Rennes, Rennes, France
| | - S Leguy
- Inserm, CIC 1414 [(centre d'investigation clinique de Rennes)], neurology, université Rennes, CHU Rennes, 35000 Rennes, France
| | - C Lebrun-Frenay
- CRCSEP, CHU de Nice Pasteur 2, Université Nice Côte d'Azur UR2CA URRIS, Nice, France.
| |
Collapse
|
3
|
Hofkamp MP, Galvan JM. Anesthetic management for cesarean section and tubal ligation in a patient with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches. Proc AMIA Symp 2018; 31:530-531. [PMID: 30949003 PMCID: PMC6413975 DOI: 10.1080/08998280.2018.1499318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022] Open
Abstract
We report a 29-year-old woman with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches who presented for a scheduled repeat cesarean delivery with bilateral tubal ligation at 37 weeks gestation. During an outpatient preoperative visit, a general anesthetic plan was ultimately selected through a shared decision-making process. The patient had an uneventful general anesthetic that included a rapid sequence induction with direct laryngoscopy. Neonatal Apgar scores were 8 at 1 minute and 9 at 5 minutes. Prior to emergence, fentanyl, acetaminophen, and ketorolac were administered intravenously and a transversus abdominus plane block was performed. On the first postoperative day, the patient expressed satisfaction with the anesthetic plan and, in particular, the avoidance of a neuraxial technique and postdural puncture headache. The patient was discharged on the second postoperative day with no apparent sequelae. A neuraxial anesthetic technique is usually preferred in patients undergoing cesarean delivery, and it is safe to perform this technique in patients with either Marfan syndrome or multiple sclerosis. We formulated an anesthetic plan that honored our patient's autonomy and produced a good maternal and neonatal outcome.
Collapse
Affiliation(s)
- Michael P. Hofkamp
- Department of Anesthesiology, Scott & White Medical Center - TempleTempleTexas
| | | |
Collapse
|
4
|
Harazim H, Štourač P, Janků P, Zelinková H, Frank K, Dufek M, Štourač P. Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10-year retrospective cohort study. Brain Behav 2018; 8:e01082. [PMID: 30047260 PMCID: PMC6160638 DOI: 10.1002/brb3.1082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/22/2018] [Accepted: 07/01/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6-month postpartum period in MS parturients with and without obstetric anesthesia/analgesia. MATERIALS AND METHODS We retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD-10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test. RESULTS There were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611. CONCLUSION Neither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.
Collapse
Affiliation(s)
- Hana Harazim
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Pavel Štourač
- Department of Neurology, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Petr Janků
- Department of Gynaecology and Obstetrics, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Hana Zelinková
- Institute of Biostatistics and Analysis, Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Kamil Frank
- Department of Gynaecology and Obstetrics, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Michal Dufek
- First Department of Neurology, Medical Faculty of Masaryk University, St Anne's University Hospital, Brno, Czech Republic
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Caring for women with multiple sclerosis (MS), whose first symptoms typically begin during the childbearing years, requires a comprehensive approach to management across a range of reproductive exposures, and beyond through menopause. RECENT FINDINGS This article summarizes what is known about the disease course in women with MS, how it differs from men, and the current state of knowledge regarding effects of reproductive exposures (menarche, childbearing, menopause) on MS-related inflammation and neurodegeneration. Recent findings regarding pregnancy-associated relapses in the treatment era, protective effects of breastfeeding, and care for women during the menopausal transition are reviewed. Then, updated recommendations to guiding women during childbearing-including pre-conception counseling, discontinuation of MS therapies, and management of postpartum relapses-are provided. Whenever possible, areas of uncertainty and avenues for future research are highlighted. From childhood through the postreproductive life stages, gender and hormonal exposures appear to shape an individual's risk for MS, as well as the experience of living with MS.
Collapse
Affiliation(s)
- Kelsey Rankin
- Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, USA.
| |
Collapse
|
6
|
Wu Q, Chen B, Liu N, Hu Y, Pan C, Zhang P, Tang ZP, Bu BT. Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium. Chin Med J (Engl) 2018; 130:1791-1795. [PMID: 28748851 PMCID: PMC5547830 DOI: 10.4103/0366-6999.211542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium. Methods: Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied. Records of clinical features, neuroimaging, serum antibodies, cerebrospinal fluid (CSF) findings, annualized relapse rate (ARR), and treatment were analyzed. Results: Among 14 patients, 5 patients were diagnosed with multiple sclerosis (MS), four as neuromyelitis optica (NMO), two as longitudinal extensive transverse myelitis, two as clinical isolated syndrome (CIS), and one as acute brainstem syndrome. All the 14 puerperal female patients presented with more than one manifestation of hemiplegia, paraplegia, uroschesis, visual loss or dysarthria, and with mild to moderate abnormalities of CSF. Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way (n = 10). Median Expanded Disability Status Scale (EDSS) scores were 5.0 (range: 2.0–9.0) at the onset and 2.5 (range: 0–7.0) at the end of follow-ups. Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders (P < 0.05). Median ARR was 0.46 (range: 0–1.16); all patients had a low ARR (0.49 ± 0.34, 95% confidence interval: 0.29–0.69) with standardized treatments. Conclusion: Labor-related alterations in the mother's immune system might result in newly-onset demyelinating diseases of central nervous system.
Collapse
Affiliation(s)
- Qian Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bo Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Na Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Hu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhou-Ping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bi-Tao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| |
Collapse
|
7
|
Lavie C, Rollot F, Durand-Dubief F, Marignier R, Ionescu I, Casey R, Moreau T, Tourniaire P, Hutchinson M, D’Hooghe MB, Laplaud DA, Clavelou P, De Sèze J, Debouverie M, Brassat D, Pelletier J, Lebrun-Frenay C, Le Page E, Castelnovo G, Berger E, Hautecoeur P, Heinzlef O, Durelli L, Clerico M, Trojano M, Patti F, Vukusic S, Alpérovitch A, Carton H, d’Hooghe M, Hommes O, Hutchinson M, Adeleine P, Biron A, Cortinovis-Tourniaire P, Grimaud J, Hours M, Moreau T, Vukusic S, Confavreux C, Chauplannaz G, Confavreux C, Cortinovis-Tourniaire P, Grimaud J, Latombe D, Moreau T, Clanet M, Lau G, Rumbach L, Goas J, Rouhart F, Mazingue A, Roullet E, Madigand M, Hautecoeur P, Brunet P, Edan G, Allaire C, Riffault G, Leche J, Benoit T, Simonin C, Ziegler F, Baron J, Rivrain Y, Dumas R, Loche D, Bourrin J, Huttin B, Delisse B, Gibert I, Boulay C, Verceletto M, Durand G, Bonneviot G, Gil R, Hedreville M, Belair C, Poitevin R, Devoize J, Wyremblewski P, Delestre F, Setiey A, Comi G, Filippi M, Ghezzi A, Martinelli V, Rossi P, Zaffaroni M, Tola M, Amato M, Fioretti C, Meucci G, Inglese M, Mancardi G, Gambi D, Thomas A, Cavazzuti M, Citterio A, Heltberg A, Hansen H, Fernandez O, Romero F, Arbizu T, Hernandez J, De Andres de Frutos C, Geffner Sclarky D, Aladro Benito Y, Reyes Yanes P, Aguilar M, Burguera J, Yaya R, Bonakim Dib W, Arzua-Mouronte D, d’Hooghe M, Sindic C, Carton H, Medaer R, Roose H, Geens K, Guillaume D, Van Zandycke M, Janssens J, Cornette M, Mol L, Weilbach F, Flachenecker P, Hartung H, Haas J, Tendolkar I, Sindrn E, Kölmel H, Reichel D, Rauch M, Preuss S, Poser S, Mauch E, Strausser-Fuchs S, Kolleger H, Hawkins S, Howell S, Rees J, Thompson A, Johnson M, Boggild M, Gregory R, Bates D, Bone I, Hutchinson M, Polman C, Frequin S, Jongen P, Hommes O, Correia de Sa J, Rio M, Huber S, Lechner-Scott J, Kappos L, Ionescu I, Cornu C, Confavreux C, Vukusic S, El-Etr M, Baulieu E, El-Etr M, Schumacher M, Ionescu I, Confavreux C, Cornu C, Vukusic S, Hartung H, Miller D, Hutchinson M, Pugeat M, d’Archangues C, Conard J, Ménard J, Sitruk-Ware R, Pelissier C, Dat S, Belaïsch-Allard J, Athéa N, Büschsenschutz D, Lyon-Caen O, Gonsette R, Boissel J, Ffrench P, Durand-Dubief F, Cotton F, Pachai C, Bracoud L, Vukusic S, Ionescu I, Androdias G, Marignier R, Chauplannaz G, Laplaud D, Wiertlewski S, Lanctin-Garcia C, Moreau T, Couvreur G, Madinier G, Clavelou P, Taithe F, Aufauvre D, Guy N, Ferrier A, De Sèze J, Collongues N, Debouverie M, Viala F, Brassat D, Gerdelat-Mas A, Henry P, Pelletier J, Rico-Lamy A, Lebrun-Frenay C, Lepage E, Deburghraeve V, Edan G, Castelnovo G, Berger E, Hautecoeur P, Blondiau M, Heinzlef O, Coustans M, Clerc C, Rieu L, Lauxerois M, Hinzelin G, Ouallet J, Minier D, Vion P, Gromaire-Fayolle N, Derache N, Thouvenot E, Sallansonnet-Froment M, Tourniaire P, Toureille L, Borgel F, Stankoff B, Grimaud J, Moroianu C, Guennoc A, Tournier-Gervason C, Peysson S, Trojano M, Patti F, D’Amico E, Motti L, Zaffaroni M, Durelli L, Tavella A. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler 2018; 25:591-600. [DOI: 10.1177/1352458518763080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
Collapse
Affiliation(s)
- Caroline Lavie
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | | | - Romain Marignier
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France
| | - Iuliana Ionescu
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | - Thibault Moreau
- Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France
| | | | - Michael Hutchinson
- School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland
| | - Marie Béatrice D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - David-Axel Laplaud
- Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France
| | - Marc Debouverie
- EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France
| | - David Brassat
- Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France
| | | | - Emmanuelle Le Page
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France
| | | | - Eric Berger
- Department of Neurology, CHU Besançon, Besançon,
France
| | - Patrick Hautecoeur
- Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France
| | - Luca Durelli
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Marinella Clerico
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bornemann-Cimenti H, Sivro N, Toft F, Halb L, Sandner-Kiesling A. [Neuraxial anesthesia in patients with multiple sclerosis - a systematic review]. Rev Bras Anestesiol 2017; 67:404-410. [PMID: 28532673 DOI: 10.1016/j.bjan.2016.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/06/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. METHODS A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. RESULTS AND CONCLUSIONS Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis.
Collapse
Affiliation(s)
- Helmar Bornemann-Cimenti
- Medical University of Graz, Department of Anaesthesiology and Intensive Care Medicine, Graz, Áustria.
| | - Nikki Sivro
- Medical University of Graz, Department of Anaesthesiology and Intensive Care Medicine, Graz, Áustria
| | - Frederike Toft
- Medical University of Graz, Department of Anaesthesiology and Intensive Care Medicine, Graz, Áustria
| | - Larissa Halb
- Medical University of Graz, Department of Anaesthesiology and Intensive Care Medicine, Graz, Áustria
| | - Andreas Sandner-Kiesling
- Medical University of Graz, Department of Anaesthesiology and Intensive Care Medicine, Graz, Áustria
| |
Collapse
|
9
|
|
10
|
Greene N, Dinges E, Ciliberto C, Sedensky M, Landau R. Spinal anesthesia for cesarean delivery in a woman with neuromyelitis optica. ACTA ACUST UNITED AC 2015; 2:108-10. [PMID: 25611874 DOI: 10.1213/xaa.0000000000000016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neuromyelitis optica (NMO), or Devic's disease, is an idiopathic severe demyelinating disease that preferentially affects the optic nerve and spinal cord. Neuraxial anesthesia in women with multiple sclerosis is widely accepted, but reports of the use of neuraxial anesthesia in patients with NMO are scarce. We report the case of a morbidly obese primigravida undergoing a planned cesarean delivery at 32 weeks' gestation due to an acute exacerbation of NMO, managed with spinal anesthesia. Other than increased intraoperative hyperalgesia requiring inhaled nitrous oxide/oxygen, the mother experienced no apparent anesthetic-related complications.
Collapse
Affiliation(s)
- Nathaniel Greene
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | | | | | | |
Collapse
|
11
|
Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol 2015; 124:1157-1168. [PMID: 25415167 DOI: 10.1097/aog.0000000000000541] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the evidence guiding management of multiple sclerosis (MS) in reproductive-aged women. DATA SOURCES We conducted an electronic literature search using PubMed, ClinicalTrials.gov, and other available resources. The following keywords were used: "multiple sclerosis" and "pregnancy." We manually searched the reference lists of identified studies. METHODS OF STUDY SELECTION Two reviewers categorized all studies identified in the search by management topic, including effect of pregnancy on MS course, fetal risks associated with disease-modifying treatments during pregnancy, and management of patients off disease-modifying treatment. We categorized studies by strength of evidence and included prior meta-analyses and systematic studies. These studies were then summarized and discussed by an expert multidisciplinary team. TABULATION, INTEGRATION, AND RESULTS The risk of MS relapses is decreased during pregnancy and increased postpartum. Data are lacking regarding the risks of disease-modifying treatments during pregnancy. There may be an increased risk of MS relapses after use of assisted reproductive techniques. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS. CONCLUSION Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.
Collapse
|
12
|
Quispe Ricci AC. Management of anesthesia during C-section of a multiple sclerosis pregnant woman: Case report and literature review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
13
|
|
14
|
Management of anesthesia during C-section of a multiple sclerosis pregnant woman: Case report and literature review☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543010-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
15
|
Quispe Ricci AC. Manejo anestésico en cesárea de una gestante con esclerosis múltiple: reporte de un caso y revisión de la literatura. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Bodiguel E, Bensa C, Brassat D, Laplaud D, Le Page E, Ouallet JC, Zephir H, De Seze J. Multiple sclerosis and pregnancy. Rev Neurol (Paris) 2014; 170:247-65. [PMID: 24684929 DOI: 10.1016/j.neurol.2013.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/26/2013] [Indexed: 10/25/2022]
Abstract
The question of pregnancy in patients with multiple sclerosis is regularly raised due to the prevalence of the disease in middle age women. The multiple sclerosis think tank (Groupe de Réflexion sur la Sclérose en Plaques [GRESEP]) decided to develop recommendations on this issue, with consideration to both the impact of multiple sclerosis on pregnancy, and that of pregnancy on the disease. As with topics of previous works, the formal expert consensus method was used. The working group was composed of hospital-based and private practice neurologists. The reading group was composed of neurologists, anaesthetists and obstetricians. Each recommendation is presented with the relevant level of consensus.
Collapse
Affiliation(s)
- E Bodiguel
- Hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France.
| | - C Bensa
- Service de neurologie, fondation Rothschild, 25, rue Manin, 75019 Paris, France
| | - D Brassat
- Inserm U1043, pôle des neurosciences, hôpital Purpan, université Toulouse-3, place du Dr-Baylac, BP 3028, 31024 Toulouse cedex 3, France
| | - D Laplaud
- Inserm UMR643, service de neurologie, pavillon Jean-Monnet, hôtel-Dieu, CHU de Nantes, 30, boulevard Jean-Monnet, 44093 Nantes 01, France; Faculté de médecine de Nantes, 1, rue Gaston-Veïl, 44000 Nantes, France
| | - E Le Page
- CIC-P 0203 Inserm, pôle des neurosciences cliniques, CHU Pontchaillou, pavillon Clemenceau, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - J-C Ouallet
- Pôle des neurosciences cliniques, université de Bordeaux Segalen, CHU de Bordeaux Pellegrin Tripode, 1, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - H Zephir
- Pôle de neurologie, hôpital Roger-Salengro, CHRU de Lille, avenue du Pr-Émile-Laine, 59037 Lille, France
| | - J De Seze
- Service de neurologie, laboratoire d'imagerie et de neurosciences cognitives (LINC), CNRS, centre d'investigation clinique (CIC) de Strasbourg, université de Strasbourg, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| |
Collapse
|
17
|
Makris A, Piperopoulos A, Karmaniolou I. Multiple sclerosis: basic knowledge and new insights in perioperative management. J Anesth 2013; 28:267-78. [DOI: 10.1007/s00540-013-1697-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/06/2013] [Indexed: 01/24/2023]
|
18
|
Abstract
Multiple sclerosis is the most common chronic neurologic disability in young adults in their childbearing ages of 20 to 45. The disease affects more women than men, which prompts discussion of pregnancy-related issues in a woman with multiple sclerosis. Preconceptual counseling to discuss the safety of medications in pregnancy, the antepartum period along with what the patient can expect during birth, and the postpartum period will be discussed.
Collapse
|
19
|
Griffiths S, Durbridge JA. Anaesthetic implications of neurological disease in pregnancy. ACTA ACUST UNITED AC 2011. [DOI: 10.1093/bjaceaccp/mkr023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Abstract
The management of acute pain remains challenging, with many patients suffering inadequate pain control following surgery. Certain populations are at unique risk for unrelieved pain. Evidence-based approaches taking into account patients' specific needs and problems will likely substantially improve their perioperative experience. These patients must be identified in the preoperative process, and an anesthetic/analgesic plan discussed and formulated. A targeted multimodal approach to pain management should be considered the best clinical practice. The most challenging patients may benefit most from the surveillance of an acute pain service that is able to monitor and coordinate care into the postoperative period.
Collapse
Affiliation(s)
- Kishor Gandhi
- Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, 111 South 11th Street, Suite 8490, Philadelphia, PA 19107, USA.
| | | | | |
Collapse
|
21
|
|
22
|
Abstract
During the previous decades, women with Multiple Sclerosis (MS) were discouraged from having children, as pregnancy was deemed dangerous for pregnancy outcome and a contributing factor for exacerbation of MS. Current knowledge shows that women with MS are no more likely to have pregnancy or delivery complications compared to healthy women. Immunomodulatory therapies should be avoided during pregnancy and while breastfeeding. However, despite that it is still not recommended during pregnancy, Glatiramer acetate has fewer risks than the other MS drugs with respect to pregnancy outcome. IVIg treatment appears to be safe in unblinded studies and may be used after the first trimester to prevent the exacerbation of postpartum relapses. Gestation is a period of decreased risk for a relapse, whereas relapses are more common in the first six months after childbirth, compared to the pre-pregnancy period. Breastfeeding and epidural anaesthesia are not associated with increased incidence of post-partum relapses.
Collapse
Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, Saint Andrew's General Hospital of Patras, Greece.
| | | |
Collapse
|
23
|
Lee AR, Hyun SJ, Choi DH. Combined spinal-epidural anesthesia for caesarian section in a patients with multiple sclerosis - A case report -. Korean J Anesthesiol 2009; 57:367-370. [DOI: 10.4097/kjae.2009.57.3.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ae Ryoung Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-ji Hyun
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Hwan Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Neurological complications following central neuraxial blockades in obstetrics. Curr Opin Anaesthesiol 2008; 21:275-80. [DOI: 10.1097/aco.0b013e3282f8e22f] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
25
|
May AE, Fombon FN, Francis S. UK registry of high-risk obstetric anaesthesia: report on neurological disease. Int J Obstet Anesth 2007; 17:31-6. [PMID: 17981456 DOI: 10.1016/j.ijoa.2007.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 03/01/2007] [Indexed: 10/22/2022]
Abstract
The UK registry of high-risk obstetric anaesthesia was set up in 1996 to collect reports of high-risk pregnancy, pool them into a central database and make them available to obstetric anaesthetists. This paper summarises the data relating to 102 patients with neurological disease who were reported to the registry between 1997 and 2002. The two most common conditions reported were spina bifida and multiple sclerosis. We describe the features and management of these and other cases.
Collapse
Affiliation(s)
- A E May
- Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
| | | | | |
Collapse
|
26
|
Brambrink AM, Kirsch JR. Perioperative care of patients with neuromuscular disease and dysfunction. Anesthesiol Clin 2007; 25:483-509, viii-ix. [PMID: 17884705 DOI: 10.1016/j.anclin.2007.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A variety of different pathologies result in disease phenotypes that are summarized as neuromuscular diseases because they share commonalty in their clinical consequences for the patient: a progressive weakening of the skeletal muscles. Distinct caution and appropriate changes to the anesthetic plan are advised when care is provided during the perioperative period. The choice of anesthetic technique, anesthetic drugs, and neuromuscular blockade always depends on the type of neuromuscular disease and the surgical procedure planned. A clear diagnosis of the underlying disease and sufficient knowledge and understanding of the pathophysiology are of paramount importance to the practitioner and guide optimal perioperative management of affected patients.
Collapse
Affiliation(s)
- Ansgar M Brambrink
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | | |
Collapse
|
27
|
Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|