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Censi ST, Mariani-Costantini R, Granzotto A, Tomassini V, Sensi SL. Endogenous retroviruses in multiple sclerosis: A network-based etiopathogenic model. Ageing Res Rev 2024; 99:102392. [PMID: 38925481 DOI: 10.1016/j.arr.2024.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
The present perspective article proposes an etiopathological model for multiple sclerosis pathogenesis and progression associated with the activation of human endogenous retroviruses. We reviewed preclinical, clinical, epidemiological, and evolutionary evidence indicating how the complex, multi-level interplay of genetic traits and environmental factors contributes to multiple sclerosis. We propose that endogenous retroviruses transactivation acts as a critical node in disease development. We also discuss the rationale for combined anti-retroviral therapy in multiple sclerosis as a disease-modifying therapeutic strategy. Finally, we propose that the immuno-pathogenic process triggered by endogenous retrovirus activation can be extended to aging and aging-related neurodegeneration. In this regard, endogenous retroviruses can be envisioned to act as epigenetic noise, favoring the proliferation of disorganized cellular subpopulations and accelerating system-specific "aging". Since inflammation and aging are two sides of the same coin (plastic dis-adaptation to external stimuli with system-specific degree of freedom), the two conditions may be epiphenomenal products of increased epigenomic entropy. Inflammation accelerates organ-specific aging, disrupting communication throughout critical systems of the body and producing symptoms. Overlapping neurological symptoms and syndromes may emerge from the activity of shared molecular networks that respond to endogenous retroviruses' reactivation.
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Affiliation(s)
- Stefano T Censi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy.
| | - Renato Mariani-Costantini
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Alberto Granzotto
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Valentina Tomassini
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy; Multiple Sclerosis Centre, Institute of Neurology, SS Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy; Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University, Chieti-Pescara, Italy; Multiple Sclerosis Centre, Institute of Neurology, SS Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy.
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Graham EL, Bove R, Costello K, Crayton H, Jacobs DA, Shah S, Sorrell F, Stoll SS, Houtchens MK. Practical Considerations for Managing Pregnancy in Patients With Multiple Sclerosis: Dispelling the Myths. Neurol Clin Pract 2024; 14:e200253. [PMID: 38585436 PMCID: PMC10996912 DOI: 10.1212/cpj.0000000000200253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review Lack of consistent data and guidance have led to variations between clinicians in the management of pregnancy in women with multiple sclerosis (MS). Pregnant and/or lactating women are often excluded from clinical trials conducted in MS, and thus, the labeling for most disease-modifying therapies (DMTs) excludes use during pregnancy. This has led to heterogeneity in interpretation and labeling regarding the safety of DMTs during pregnancy and lactation and the required preconception washout periods. This review identifies key themes where there is conflicting information surrounding family planning and pregnancy in MS, focusing on the most common discussion points between physicians and patients during preconception planning, pregnancy, postpartum, and lactation. The goal was to inform the patient-physician conversation and provide best practice recommendations based on expert clinical expertise and experience. Recent Findings We outline the latest evidence-based data for DMT use during pregnancy and lactation, the effect of MS on fertility and fertility treatments, the risk of adverse pregnancy and delivery outcomes, the risk of postpartum relapse, and immunization and clinical imaging safety during pregnancy and breastfeeding. Summary Management of family planning and pregnancy in patients with MS requires the most current information. Health care providers should discuss family planning early and frequently with patients with MS, and partners where practicable. Because management of pregnant people with MS will often require a risk/benefit analysis of their needs, shared decision-making in family planning discussions is emphasized. Additional data are needed for specific and underrepresented populations with MS (e.g., single parents or those from the LGBTQ+ community) and those at risk of racial and socioeconomic disparities in care. Pregnancy registries and the design and conduct of clinical trials focused on pregnant and lactating patients should provide additional data to guide the ongoing management of patients with MS.
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Affiliation(s)
- Edith L Graham
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Riley Bove
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kathleen Costello
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Heidi Crayton
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dina A Jacobs
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Suma Shah
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francesca Sorrell
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharon S Stoll
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maria K Houtchens
- Department of Neurology (ELG), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (RB), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Can Do Multiple Sclerosis (KC), Avon, CO; Multiple Sclerosis Center of Greater Washington (HC), Vienna, VA; Department of Neurology (DAJ), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (SS), Duke University School of Medicine, Durham, NC; Envision Pharma Group (FS), Glasgow, UK; Stoll Medical Group (SSS), Philadelphia, PA; and Brigham Multiple Sclerosis Center (MKH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmun Rev 2024; 23:103499. [PMID: 38061621 DOI: 10.1016/j.autrev.2023.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system autoimmune disease. Aquaporin-4 antibody (AQP4-IgG) is present in over 75% of cases and criteria also exist for the diagnosis of seronegative NMOSD. AQP4-IgG NMOSD has a strong female predominance (9:1 ratio), with a median onset age of 40 years. Pregnancy in those with NMOSD is therefore an important topic. Fecundity in NMOSD is likely impaired, and for females who conceive, obstetric complications including miscarriages and pre-eclampsia are significantly higher in NMOSD compared to the general population and in related conditions such as multiple sclerosis (MS). In contrast to MS, NMOSD disease activity does not subside during pregnancy. Also, relapse risk substantially rises above pre-pregnancy rates in the early postpartum period. In view of the evolving landscape of NMOSD, we provide a contemporary update of the impacts of pregnancy in NMOSD.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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Schubert C, Steinberg L, Peper J, Ramien C, Hellwig K, Köpke S, Solari A, Giordano A, Gold SM, Friede T, Heesen C, Rahn AC. Postpartum relapse risk in multiple sclerosis: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:718-725. [PMID: 36807056 DOI: 10.1136/jnnp-2022-330533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
The influence of pregnancy on the course of multiple sclerosis (MS) has long been controversial. While historical evidence suggests a substantial decline in relapse rates during pregnancy followed by a rebound in the postpartum period, more recent work yielded equivocal results. We performed a systematic review and meta-analysis on data from cohort studies to determine whether women with MS experience increased relapse rates after delivery. A systematic literature search was conducted in the databases MEDLINE and Epistemonikos on the topic 'motherhood choice in MS' in March 2022. We included cohort studies assessing the association between pregnancy and MS relapse activity defined by the annualised relapse rate after 3, 6, 9 and 12 months post partum. Furthermore, information about disease-modifying therapies (DMT) and breast feeding was considered, if available. 5369 publications were identified. Of these, 93 full-text articles on MS relapse activity during the postpartum period were screened. 11 studies including 2739 pregnancies were eligible. Women with MS showed a significantly increased relapse rate in the first 6 months post partum, compared with preconception with the incidence rate ratio (IRR) almost doubled in the first 3 months post partum (1.87, 95% CI 1.40 to 2.50). However, at 10-12 months post partum, the IRR decreased significantly (0.81, 95% CI 0.67 to 0.98). Subanalysis on influencing parameters suggested that preconceptional DMTs (IRR for highly-effective DMTs 2.76, 95% CI 1.34 to 5.69) and exclusive breast feeding (risk ratio 0.39, 95% CI 0.18 to 0.86) significantly influenced postpartum relapse risk. Increased postpartum annualised relapse rate and possible modifiers should be considered in counselling women with MS who are considering pregnancy.
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Affiliation(s)
- Charlotte Schubert
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea Steinberg
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Peper
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Caren Ramien
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Hellwig
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Sascha Köpke
- Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Köln, Germany
| | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Neurosciences, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Tim Friede
- Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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5
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Leite MI, Panahloo Z, Harrison N, Palace J. A systematic literature review to examine the considerations around pregnancy in women of child-bearing age with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) or aquaporin 4 neuromyelitis optica spectrum disorder (AQP4+ NMOSD). Mult Scler Relat Disord 2023; 75:104760. [PMID: 37224631 DOI: 10.1016/j.msard.2023.104760] [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: 01/10/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Aquaporin-4 antibody positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare autoimmune diseases with overlapping phenotypes. Understanding their clinical manifestation prior to, during and after pregnancy may influence the management of women of child-bearing age (WOCBA) with these diseases. METHODS This systematic review identified relevant MEDLINE-indexed publications dated between 01 January 2011 and 01 November 2021, and congress materials from key conferences between 01 January 2019 and 01 November 2021. These were manually assessed for relevance to AQP4+ NMOSD and/or MOGAD in WOCBA, with selected data extracted and considered. RESULTS In total, 107 articles were retrieved and reviewed for relevancy, including 65 clinical studies. Limited evidence was found regarding a conclusive impact of either disease on female fertility, sexual function or menarche, and impact on maternal outcomes requires further investigation in both conditions to establish risk for pre-eclampsia, gestational diabetes and other complications relative to the general population. Collated data for pregnancy outcomes show clear risks in AQP4+ NMOSD to healthy delivery and a rise in annualised relapse rate postpartum that may require adaptation of treatment regimens. Disease activity appears to be attenuated during pregnancy in MOGAD patients with an increased risk of relapse during the postpartum months, but strong conclusions cannot be made due to a paucity of available data. CONCLUSIONS This review brings together the literature on AQP4+ NMOSD and MOGAD in WOCBA. The potential impact of pregnancy and the postpartum period on disease activity suggest a proactive management strategy early on may improve maternal and infant outcomes, but more clinical data are needed, particularly for MOGAD.
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Affiliation(s)
- M Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
| | | | | | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
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Kim W, Kim HJ. An update on biologic treatments for neuromyelitis optica spectrum disorder. Expert Rev Clin Immunol 2023; 19:111-121. [PMID: 36414430 DOI: 10.1080/1744666x.2023.2151441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system mediated by antibodies targeting the aquaporin-4 (AQP4) water channel expressed on astrocytes. The binding of specific antibodies to AQP4 causes complement-dependent cytotoxicity, leading to inflammation and demyelination. Several recent phase 2 and 3 randomized placebo-controlled trials showed the efficacy and safety of monoclonal antibody therapies targeting B-cells, interleukin-6 receptor, and complement. AREAS COVERED Current biologic treatments for NMOSD and developments therein, and unresolved issues in NMOSD treatment. EXPERT OPINION New biologic treatments demonstrate high efficacy and good safety for patients with AQP4-IgG-positive NMOSD. The optimal therapeutics for seronegative NMOSD, pediatric patients, and female patients who are pregnant or wish to be are unclear, and further research is needed. Also, real-world studies of new biological agents and the data on the durability of their beneficial effects and their long-term safety are required. Effective rescue therapy for an acute attack is critical given permanent disability in NMOSD is attack-related, and biologic agents that treat acute attack are emerging. If such treatments are to become widely applied, studies on the most cost-effective treatment strategies are needed.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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Vukusic S, Marignier R, Ciron J, Bourre B, Cohen M, Deschamps R, Guillaume M, Kremer L, Pique J, Carra-Dalliere C, Michel L, Leray E, Guennoc AM, Laplaud D, Androdias G, Bensa C, Bigaut K, Biotti D, Branger P, Casez O, Daval E, Donze C, Dubessy AL, Dulau C, Durand-Dubief F, Hebant B, Kwiatkowski A, Lannoy J, Maarouf A, Manchon E, Mathey G, Moisset X, Montcuquet A, Roux T, Maillart E, Lebrun-Frenay C. Pregnancy and neuromyelitis optica spectrum disorders: 2022 recommendations from the French Multiple Sclerosis Society. Mult Scler 2023; 29:37-51. [PMID: 36345839 DOI: 10.1177/13524585221130934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As neuromyelitis optica spectrum disorders (NMOSD) shares a series of commonalities with MS, but also some significant differences, specific recommendations had to be developed. OBJECTIVES To establish recommendations on pregnancy in women with NMOSD. METHODS The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and universities databases (January 1975 through June 2021). The RAND/UCLA appropriateness method, which was developed to synthesise the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A sub-group of nine NMOSD experts was dedicated to analysing available data on NMOSD. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. RESULTS A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, loco-regional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments. CONCLUSION Physicians and patients should be aware of the new and specific evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD. They should help harmonise counselling and treatment practise, allowing for better individualised choices.
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Affiliation(s)
- Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France/INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, Lyon, France/Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France/Eugène Devic EDMUS Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Romain Marignier
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France/Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron, France/FORGETTING Team, INSERM 1028 et CNRS UMR5292, Centre des Neurosciences de Lyon, Lyon, France
| | - Jonathan Ciron
- Centre Ressources et Compétences Sclérose en Plaques (CRC-SEP) et Service de Neurologie B4, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, Toulouse, France/INSERM UMR1291 - CNRS UMR5051, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III, Toulouse, France
| | | | - Mikael Cohen
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, Nice, France/UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Romain Deschamps
- CRC-SEP, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Laurent Kremer
- CRC-SEP, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Pique
- Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Clarisse Carra-Dalliere
- CRC-SEP, Neurology Department, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France
| | - Laure Michel
- CIC_P1414 INSERM, Neurology Department, Rennes University Hospital, Rennes, France
| | - Emmanuelle Leray
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé), Université de Rennes, Rennes, France
| | | | - David Laplaud
- INSERM, Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France/CIC INSERM 1413, CRC-SEP Pays de la Loire, CHU Nantes, Nantes, France
| | - Géraldine Androdias
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France/Ramsay Santé, Clinique de la Sauvegarde, Lyon, France
| | - Caroline Bensa
- CRC-SEP, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kevin Bigaut
- CRC-SEP, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Damien Biotti
- Centre Ressources et Compétences Sclérose en Plaques (CRC-SEP) et Service de Neurologie B4, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, Toulouse, France/INSERM UMR1291 - CNRS UMR5051, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III, Toulouse, France
| | - Pierre Branger
- Service de Neurologie, CHU de Caen Normandie, Caen, France
| | - Olivier Casez
- Neurologie, Pathologies Inflammatoires du Système Nerveux, CHU Grenoble Alpes, Grenoble, France/TIMC-IMAG, T-RAIG (Translational Research in Autoimmunity and Inflammation Group), Université de Grenoble Alpes, Grenoble, France
| | - Elodie Daval
- Service de Neurologie, CHU de Besançon, Besançon, France
| | - Cécile Donze
- Faculté de Médecine et de Maïeutique de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille, Hôpital Saint Philibert, Lille, France
| | - Anne-Laure Dubessy
- APHP-6, Department of Neurology, Saint-Antoine Hospital, Paris, France/Sorbonne University, Paris, France
| | - Cécile Dulau
- CRC-SEP, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Françoise Durand-Dubief
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | | | - Arnaud Kwiatkowski
- Department of Neurology, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Julien Lannoy
- Service de Neurologie, Centre Hospitalier de Lens, Lens, France
| | - Adil Maarouf
- CNRS, CRMBM, UMR 7339, Aix-Marseille Université, Marseille, France/APHM, Hôpital de la Timone, Marseille, France
| | - Eric Manchon
- Department of Neurology, Gonesse Hospital, Gonesse, France
| | - Guillaume Mathey
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Xavier Moisset
- Inserm, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France/Department of Neurology et CRC-SEP, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Thomas Roux
- CRC-SEP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Elisabeth Maillart
- CRC-SEP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Christine Lebrun-Frenay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, Nice, France/UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
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8
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Cortese R, Mariotto S, Mancinelli CR, Tortorella C. Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know? Front Neurol 2022; 13:1048502. [PMID: 36601293 PMCID: PMC9806181 DOI: 10.3389/fneur.2022.1048502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,*Correspondence: Rosa Cortese
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
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9
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Du Q, Shi Z, Chen H, Zhang Y, Qiu Y, Lang Y, Kong L, Zhou H. Effects of pregnancy on neuromyelitis optica spectrum disorder and predictors of related attacks. Ann Clin Transl Neurol 2022; 9:1918-1925. [PMID: 36314431 PMCID: PMC9735372 DOI: 10.1002/acn3.51683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 09/11/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Our study aimed to investigate the influence of pregnancy on the course of neuromyelitis optica spectrum disorders (NMOSD) and to explore the independent predictors of pregnancy-related attacks. METHODS We performed a retrospective study of patients with NMOSD based on the Wingerchuk 2006 or the revised Wingerchuk 2015 criteria. Demographic, clinical, and pregnancy data were recorded. We compared the annualized relapse rate (ARR) before, during, and after pregnancy. The Expanded Disability Status Scale (EDSS) score was used to assess the degree of disability. Multivariate Cox proportional hazards models were used to identify the independent risk factors that predict pregnancy-related attacks. RESULTS There were 202 informative pregnancies following symptom onset in 112 women with NMOSD. The ARR in the first-trimester postpartum period (1.44 ± 2.04) was higher than that before pregnancy (0.23 ± 0.48; p < 0.001) and during pregnancy. The EDSS score increased from 1.40 ± 1.38 before pregnancy to 1.99 ± 1.78 postpartum (p = 0.004). Multivariate Cox proportional hazards models indicated that increased disease activity 1 year before conception (HR = 1.79, 95% CI 1.09-2.92, p = 0.021) and lack of immunotherapy during pregnancy and the postpartum period (HR = 5.25, 95% CI 1.91-14.42, p = 0.001) were independent risk factors that predicted pregnancy-related attacks. INTERPRETATION The postpartum period is a particularly high-risk time for the onset and relapse of NMOSD. Pregnancy exerted detrimental effects on the disease courses of NMOSD. Immunotherapy during pregnancy and the postpartum period might be recommended to decrease the risk of pregnancy-related attacks. Larger-scale prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Qin Du
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Ziyan Shi
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Hongxi Chen
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Ying Zhang
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Yuhan Qiu
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Yanlin Lang
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Lingyao Kong
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Hongyu Zhou
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
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Costello F, Burton JM. Contemporary management challenges in seropositive NMOSD. J Neurol 2022; 269:5674-5681. [PMID: 35816205 PMCID: PMC9272395 DOI: 10.1007/s00415-022-11241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory disorder of the central nervous system that presents unique management challenges. Neurologic disability in NMOSD is directly linked to acute attacks, therefore, relapse prevention is an overarching goal of care. To this end, identifying effective biomarkers that predict relapse onset and severity is of critical importance. As treatment becomes more precision-based and patient-centred, clinicians will need to be familiar with managing circumstances of particular vulnerability for patients with NMOSD, including infection, pregnancy, and the post-partum phase. The discovery of the pathogenic aquaporin-4 Immunoglobulin G (AQP4 IgG) autoantibody almost 20 years ago ultimately distinguished NMOSD as an autoimmune astrocytopathy and helped spearhead recent therapeutic advancements. Targeted therapies, including eculizumab, satralizumab, and inebilizumab, approved for use in aquaporin-4 immunoglobulin G (AQP4 IgG) seropositive patients with NMOSD will likely improve outcomes, but there are formidable costs involved. Importantly, seronegative patients continue to have limited therapeutic options. Moving forward, areas of research exploration should include relapse prevention, restorative therapies, and initiatives that promote equitable access to approved therapies for all people living with NMOSD.
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Affiliation(s)
- Fiona Costello
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
- Department of Surgery, University of Calgary, Calgary, Canada.
| | - Jodie M Burton
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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11
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Deng S, Lei Q, Lu W. Pregnancy-Related Attack in Neuromyelitis Optica Spectrum Disorder With AQP4-IgG: A Single-Center Study and Meta-Analysis. Front Immunol 2022; 12:800666. [PMID: 35069584 PMCID: PMC8767555 DOI: 10.3389/fimmu.2021.800666] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to investigate the demographic characteristic of pregnancy-related attacks (PRAs) in neuromyelitis optica spectrum disorder (NMOSD). In addition, we investigated the predictors of PRAs as well as the effect of immunosuppressive (IS) therapy in patients with pregnancy-related NMOSD. Method We retrospectively analyzed data on clinical and diagnostic characteristics, therapeutic management, and pregnancy outcomes for PRAs in AQP4-IgG-positive NMOSD patients admitted to the Second Xiangya Hospital of Central South University. Moreover, we searched the literature (without any temporal restriction) to identify all such similar cohorts and performed a meta-analysis to evaluate the effectiveness and safety of IS therapy on NMOSD patients with PRAs. Result We collected clinical data on 117 women with AQP4 antibody-positive NMOSD; we ultimately included 33 patients (34 pregnancies). Ten patients were relapse-free during pregnancy, and 23 (69.7%) had PRA; attacks were most common during the first trimester of the postpartum period. Maintenance of IS treatment during pregnancy was found to greatly reduce PRAs in patients with NMOSD. PRAs were associated with a higher neutrophil-to-lymphocyte ratio (NLR) at relapse during pregnancy and shorter time interval between the last relapse and conception. The meta-analysis suggested that maintenance of IS treatment during pregnancy can significantly reduce the RR of NMOSD (95%CI=0.35-0.62; z=5.18, p<0.0001) and had no adverse effect on the miscarriage rate. However, the unhealthy newborn occurrence among those receiving IS treatment was 3.73 times higher than that of those not receiving treatment during pregnancy (95%CI=1.40–9.91; z=2.64, p=0.008). Conclusion Our study results demonstrates that pregnancy can induce the onset or relapse of attacks in NMOSD patients. The increased NLR value and disease activity may be a predictor for PRAs in patients with NMOSD. Moreover, administration of IS treatment during pregnancy can reduce the relapse rate. However, the dosage of drugs and risks of adverse effects to the fetus need to be considered. Future prospective studies with larger sample sizes are needed to confirm and extend our findings.
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Affiliation(s)
- Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Lei
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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12
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Treatment of Neuromyelitis Optica Spectrum Disorders. Int J Mol Sci 2021; 22:ijms22168638. [PMID: 34445343 PMCID: PMC8395403 DOI: 10.3390/ijms22168638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory disorder that can lead to serious disability and mortality. Females are predominantly affected, including those within the reproductive age. Most patients develop relapsing attacks of optic neuritis; longitudinally extensive transverse myelitis; and encephalitis, especially brainstem encephalitis. The majority of NMOSD patients are seropositive for IgG autoantibodies against the water channel protein aquaporin-4 (AQP4-IgG), reflecting underlying aquaporin-4 autoimmunity. Histological findings of the affected CNS tissues of patients from in-vitro and in-vivo studies support that AQP4-IgG is directly pathogenic in NMOSD. It is believed that the binding of AQP4-IgG to CNS aquaporin-4 (abundantly expressed at the endfoot processes of astrocytes) triggers astrocytopathy and neuroinflammation, resulting in acute attacks. These attacks of neuroinflammation can lead to pathologies, including aquaporin-4 loss, astrocytic activation, injury and loss, glutamate excitotoxicity, microglial activation, neuroinflammation, demyelination, and neuronal injury, via both complement-dependent and complement-independent pathophysiological mechanisms. With the increased understanding of these mechanisms underlying this serious autoimmune astrocytopathy, effective treatments for both active attacks and long-term immunosuppression to prevent relapses in NMOSD are increasingly available based on the evidence from retrospective observational data and prospective clinical trials. Knowledge on the indications and potential side effects of these medications are essential for a clear evaluation of the potential benefits and risks to NMOSD patients in a personalized manner. Special issues such as pregnancy and the coexistence of other autoimmune diseases require additional concern and meticulous care. Future directions include the identification of clinically useful biomarkers for the prediction of relapse and monitoring of the therapeutic response, as well as the development of effective medications with minimal side effects, especially opportunistic infections complicated by long-term immunosuppression.
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Jeslin J, Seetharaman C, Shah VM. Optic Neuritis During Lactation: A Case Series. J Hum Lact 2021; 37:577-580. [PMID: 33201757 DOI: 10.1177/0890334420970496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis is a rare condition that can lead to sudden blindness and also could be a precursor to multiple sclerosis. When it occurs postpartum during lactation, it is called lactation optic neuritis. MAIN ISSUE We present four cases of optic neuritis in lactating mothers, two of which had additional features of demyelinating disease upon neurological imaging. MANAGEMENT All participants were treated with high dose intravenous steroids followed by 11 days of oral steroids, per the optic neuritis treatment trial, which led to complete recovery of vision. Two participants with demyelinating disease on magnetic resonance imaging scans were advised to wean, because of a need for immunosuppressive therapy later. CONCLUSION Optic neuritis during lactation should be suspected following acute loss of vision. Prompt referral to an ophthalmologist is mandated for early diagnosis and treatment to prevent long-term co-morbidities.
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Affiliation(s)
- Johnson Jeslin
- 75196 Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - C Seetharaman
- 29908 Radiology Department, Kovai Medical Center and Hospitals, Coimbatore, India
| | - Virna M Shah
- 75196 Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
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14
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Collongues N, Alves Do Rego C, Bourre B, Biotti D, Marignier R, da Silva AM, Santos E, Maillart E, Papeix C, Palace J, Leite MIS, De Seze J. Pregnancy in Patients With AQP4-Ab, MOG-Ab, or Double-Negative Neuromyelitis Optica Disorder. Neurology 2021; 96:e2006-e2015. [PMID: 33627499 DOI: 10.1212/wnl.0000000000011744] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effects of pregnancy on neuromyelitis optica spectrum disorder (NMOSD) according to patients' serostatus and immunosuppressive therapy (IST). METHODS We performed a retrospective multicenter international study on patients with NMOSD. Patients were tested for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). Informative pregnancies were reported when NMOSD onset occurred before or during pregnancy or up to 12 months postpartum. The mean annualized relapse rate (ARR) was calculated for the 12 months before conception, for each trimester of pregnancy, and postpartum. Events such as miscarriage, abortion, and preeclampsia were reported. IST was considered if taken in the 3 months before or during pregnancy. RESULTS We included 89 pregnancies (46 with AQP4-Ab, 30 with MOG-Ab, and 13 without either Ab) in 58 patients with NMOSD. Compared to the prepregnancy period, the ARR was lower during pregnancy in each serostatus group and higher during the postpartum period in patients with AQP4-Ab (p < 0.01). Forty-eight percent (n = 31) of pregnancies occurred during IST and these patients presented fewer relapses during pregnancy and the 12 months postpartum than untreated patients (26% vs 53%, p = 0.04). Miscarriages occurred in 10 (11%) pregnancies, and were mainly in patients with AQP4-Ab (with or without IST) and a previous history of miscarriage. Preeclampsia was reported in 2 (2%) patients who were AQP4-Ab-positive. CONCLUSION We found a rebound in the ARR during the first postpartum trimester that was higher than the prepregnancy period only in AQP4-Ab-positive patients. Taking IST just before or during pregnancy reduces the risk of relapses in these conditions.
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Affiliation(s)
- Nicolas Collongues
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK.
| | - Cecilia Alves Do Rego
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Bertrand Bourre
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Damien Biotti
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Romain Marignier
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ana Martins da Silva
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ernestina Santos
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Elisabeth Maillart
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Caroline Papeix
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jacqueline Palace
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Maria Isabel S Leite
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jerome De Seze
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
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Miraclin A, Sivadasan A, Rima S, Mannam P, Gupta A, Devasia AJ, Prabhakar AT, Mathew V. Pearls & Oy-sters: Primary CNS Burkitt Lymphoma in Pregnancy: Management Challenges of a Rare Entity. Neurology 2021; 96:e2141-e2144. [PMID: 33402436 DOI: 10.1212/wnl.0000000000011495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Angel Miraclin
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajith Sivadasan
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India.
| | - S Rima
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - Pavithra Mannam
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - Ankush Gupta
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - Anup J Devasia
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - A T Prabhakar
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- From the Departments of Neurological Sciences (A.M., A.S., A.G., A.T.P., V.M.), Pathology (S.R.), Radiology (P.M.), and Haematology (A.J.D.), Christian Medical College, Vellore, Tamil Nadu, India
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D'Souza R, Wuebbolt D, Andrejevic K, Ashraf R, Nguyen V, Zaffar N, Rotstein D, Wyne A. Pregnancy and Neuromyelitis Optica Spectrum Disorder - Reciprocal Effects and Practical Recommendations: A Systematic Review. Front Neurol 2020; 11:544434. [PMID: 33178102 PMCID: PMC7596379 DOI: 10.3389/fneur.2020.544434] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system characterized by severe, antibody-mediated astrocyte loss with secondary demyelination and axonal damage, predominantly targeting optic nerves and the spinal cord. Recent publications have alluded to increased disease activity during pregnancy, and adverse maternal and fetal outcomes in patients with NMOSD. Our objective was to systematically review published literature to help counsel and manage women with NMOSD contemplating pregnancy. Methods: We searched five databases including MEDLINE and EMBASE, for English-language publications describing pregnancies in women with NMOSD. Article selection, data extraction, and risk-of-bias assessment using Joanna Briggs' critical appraisal tool for case reports and case series, were performed in duplicate. Pooled incidences were calculated where possible, and a narrative summary was provided. Results: Of 2,118 identified titles, 22 case reports and seven case series, representing 595 pregnancies in 389 women, were included. The mean maternal age was 28.12 ± 5.19 years. At least 20% of cases were first diagnosed during pregnancy. There were no maternal deaths. Pooled estimates for clinical outcomes could not be obtained due to inadequate reporting. NMOSD-related disability and relapses increased considerably during pregnancy and especially in the immediate postpartum period. Although a high proportion of early pregnancy losses were reported, an association with disease activity or therapeutic interventions could not be established. Apart from one publication which reported an increased risk of preeclampsia, there was no increase in adverse obstetric outcomes including preterm birth, fetal growth restriction or congenital malformations. Initial attacks and relapses were successfully managed with oral or intravenous corticosteroids and immunosuppressants, and refractory cases with immunoglobulin, plasma exchange and immunoadsorption. Conclusion: Increased NMOSD-related disability and relapses during pregnancy the postpartum period may respond to aggressive management with corticosteroids and immunosuppressants such as azathioprine, which are safely administered during pregnancy and lactation. Emerging safety data on monoclonal antibodies during pregnancy, make these attractive options, while intravenous immunoglobulin, plasma exchange and immunoadsorption can be safely used to treat severe relapses. The complex interplay between NMOSD and pregnancy outcomes would be best understood through prospective analysis of data collected through an international registry. Disclosure: Dalia Rotstein has served as a consultant or speaker for Alexion and Roche. She has received research support from Roche Canada. Rohan D'Souza has served as a consultant and speaker for Ferring Canada Inc and Ferring Global Inc, on topics unrelated to this manuscript. The other authors have no relevant relationships to disclose.
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Affiliation(s)
- Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Danielle Wuebbolt
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,Department of Obstetrics & Gynaecology, University of Ottawa, Ottawa, ON, Canada
| | - Katarina Andrejevic
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Western Ontario, London, ON, Canada
| | - Rizwana Ashraf
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Vanessa Nguyen
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Nusrat Zaffar
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Dalia Rotstein
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Toronto, ON, Canada
| | - Ahraaz Wyne
- General Internal and Obstetrical Medicine, Department of Medicine, Hamilton Health Sciences Center, McMaster University, Hamilton, ON, Canada
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17
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Myelin oligodendrocyte glycoprotein antibody associated central nervous system demyelinating disease: a tertiary center experience from Turkey. Mult Scler Relat Disord 2020; 44:102376. [PMID: 32674059 DOI: 10.1016/j.msard.2020.102376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/17/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND To identify the clinical and radiological characteristics of adult patients with myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) in a Turkish cohort. METHODS Clinical and radiological data were obtained retrospectively. Serological testing was done with fixed and live cell-based assays. RESULTS Optic neuritis was the most common presenting symptom, and neuromyelitis optica spectrum disorder (NMOSD) without aquaporin-4 antibody (AQP4-IgG) was the most common phenotype. Most patients had a relapsing course. Steroid dependency was common. Conus involvement was a frequent clinical and radiological feature. Radiological features such as long segment involvement and perineural optic nerve gadolinium enhancement were also typical in our cohort. One patient presented with encephalopathy and seizures, pointing out to the importance of testing of myelin oligodendrocyte antibody (MOG-IgG) in such patients as well. CONCLUSION Myelin oligodendrocyte glycoprotein antibody disease is a heterogeneous clinical entity with characteristic clinical and radiological features. Our single-center experience underlines prominent clinical and magnetic resonance imaging (MRI) features and provides our treatment experiences.
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18
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Ashtari F, Mehdipour R, Shaygannejad V, Asgari N. Pre-pregnancy, obstetric and delivery status in women with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 44:102252. [PMID: 32535502 DOI: 10.1016/j.msard.2020.102252] [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: 03/18/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a potentially disabling disease which affects predominantly women of reproductive age. OBJECTIVES To evaluate the pre-pregnancy condition and to investigate the prevalence of obstetrical and neonatal complaints in NMOSD. METHODS An observational retrospective study of 37 NMOSD patients positive for aquaporin-4-immunoglobulin-IgG. Age at menarche, menstrual cycle, gravidity, type of delivery obstetrical complications and perinatal problems were recorded. We assessed the annualized relapse rate (ARR). RESULTS A total of 23 patients (62%) suffered from irregular menstruations and two from infertility after disease onset. 11 patients had 20 informative pregnancies with 14 deliveries (5 cesareans) and six abortions, four spontaneous, and two ectopic pregnancies after the first trimester. Additionally, three patients experienced threatening abortion and one preeclampsia. No stillbirth or premature birth was recorded. None of the patients experienced attacks during pregnancy, but postpartum relapses occurred after 10 deliveries (71,4%) with the highest ARR (0.937; p = 0.037) during the first three months postpartum compared to pre-pregnancy ARR (0.375). Four patients (10.8%) developed the initial symptoms of NMOSD postpartum. CONCLUSION Irregular menstruation in more than half of NMOSD patients may reflect a hormonal imbalance. Pregnancies were associated with obstetrical complications and increased disease activity postpartum.
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Affiliation(s)
- Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roshanak Mehdipour
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Institute of Regional Health Research, Denmark; Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
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19
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Fuhler GM. The immune system and microbiome in pregnancy. Best Pract Res Clin Gastroenterol 2020; 44-45:101671. [PMID: 32359685 DOI: 10.1016/j.bpg.2020.101671] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 01/31/2023]
Abstract
Hormonal changes during pregnancy instigate numerous physiological changes aimed at the growth and delivery of a healthy baby. A careful balance between immunological tolerance against fetal antigens and immunity against infectious agents needs to be maintained. A three-way interaction between pregnancy hormones, the immune system and our microbiota is now emerging. Recent evidence suggests that microbial alterations seen during pregnancy may help maintain homeostasis and aid the required physiological changes occurring in pregnancy. However, these same immunological and microbial alterations may also make women more vulnerable during pregnancy and the post-partum period, especially regarding immunological and infectious diseases. Thus, a further understanding of the host-microbial interactions taking place during pregnancy may improve identification of populations at risk for adverse pregnancy outcomes.
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Affiliation(s)
- G M Fuhler
- Erasmus MC University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Erasmus Medical Center, Gravendijkwal 230, 3015CE, Rotterdam, the Netherlands.
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20
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Mao-Draayer Y, Thiel S, Mills EA, Chitnis T, Fabian M, Katz Sand I, Leite MI, Jarius S, Hellwig K. Neuromyelitis optica spectrum disorders and pregnancy: therapeutic considerations. Nat Rev Neurol 2020; 16:154-170. [PMID: 32080393 DOI: 10.1038/s41582-020-0313-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.
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Affiliation(s)
- Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sandra Thiel
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Michelle Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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An extremely aggressive case of Marburg's disease treated with high dose cyclophosphamide. A case report. Mult Scler Relat Disord 2019; 31:51-53. [DOI: 10.1016/j.msard.2019.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/15/2019] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
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22
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A case of neuromyelitis optica spectrum disorder following seasonal influenza vaccination. Mult Scler Relat Disord 2019; 30:110-113. [DOI: 10.1016/j.msard.2019.01.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 01/07/2023]
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