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T F Runia, R F Neuteboom, C J M de Groot, Y B de Rijke, R Q Hintzen
BACKGROUND AND PURPOSE: In relapsing-remitting MS patients, lower serum vitamin D concentrations are associated with higher relapse risk. In a number of conditions, low vitamin D has been associated with fatigue. Pregnant women are at particular risk for vitamin D insufficiency. Our objective was to investigate whether vitamin D status is associated with postpartum relapse and quality of life during pregnancy. METHODS: Forty-three pregnant relapsing-remitting MS patients and 21 pregnant controls were seen at regular times before, during and after pregnancy...
March 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Claire Bridel, Patrice H Lalive
Relapsing-remitting multiple sclerosis (RRMS) management has dramatically changed over the past decade. New drugs have arrived on the market, allowing for more individualised treatment selection. However, this diversity has increased the complexity of RRMS patient follow-up. In this review, we provide summarised information about treatment efficacy, potential side-effects, follow-up recommendations, vaccinations, and pregnancy safety issues for all currently available disease modifying therapies and those awaiting approval...
2014: Swiss Medical Weekly
M B D'hooghe, G Nagels, V Bissay, J De Keyser
A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and tetanus appear to be safe. Surgery, general and epidural anaesthesia, and physical trauma are not associated with an increased risk of relapses. Factors that have been associated with a reduced relapse rate are pregnancy, exclusive breastfeeding, sunlight exposure and higher vitamin D levels...
July 2010: Multiple Sclerosis: Clinical and Laboratory Research
Benjamin K-T Tsang, Richard Macdonell
BACKGROUND: Multiple sclerosis is the most common chronic disabling disease of the central nervous system in young adults. OBJECTIVE: This article summarises the diagnosis, management and prognosis of multiple sclerosis. DISCUSSION: Multiple sclerosis usually starts with an acute episode of neurological disturbance, termed a 'clinically isolated syndrome', followed by an illness phase punctuated by relapses and remissions which may transition after 10 years to a phase of progressive accumulation of disability without relapses...
December 2011: Australian Family Physician
Konrad Rejdak, Samuel Jackson, Gavin Giovannoni
Multiple sclerosis (MS) is the commonest disabling neurological condition to afflict young adults and therefore has a high social burden. Over several decades, there has been a considerable progress in the understanding of the disease pathogenesis as well as in the clinical management of MS patients. The emphasis in managing MS patients has shifted to multidisciplinary teams working in specialist groups. A review of the literature was conducted using MedLine to identify recent advances in MS. The current consensus is that MS is an autoimmune disease triggered by environmental agents acting in genetically susceptible people...
2010: British Medical Bulletin
Sandra Vukusic, Romain Marignier
The influence of pregnancy on the course of multiple sclerosis (MS) has long been controversial; until the end of 1990s, women with MS were discouraged from having children owing to a biased belief that pregnancy would worsen the disease course. Since the first large prospective study in 1998, counselling of women with MS has changed radically, and many patients have attained their desire of motherhood. Although many disease-modifying drugs have come to market in the past two decades, when used during pregnancy and lactation, their beneficial effects on the course of MS have to be balanced with fears concerning potential risks to the fetus or child...
May 2015: Nature Reviews. Neurology
Sandra Vukusic, Françoise Durand-Dubief, Amandine Benoit, Romain Marignier, Bernard Frangoulis, Christian Confavreux
OBJECTIVE: Our aim was to evaluate the impact of early redosing of natalizumab after delivery on the risk of post-partum relapses in six women with very active multiple sclerosis (MS). METHODS: We undertook a retrospective analysis of data collected prospectively in the Lyon MS Cohort. RESULTS: The annualized relapse rate (ARR) in the year before natalizumab treatment was 4.2 ±0.4, which decreased to 0.4 ±0.6 during the treatment period...
June 2015: Multiple Sclerosis: Clinical and Laboratory Research
Jonatan Salzer, Göran Hallmans, Maria Nyström, Hans Stenlund, Göran Wadell, Peter Sundström
OBJECTIVE: To examine the association between 25-hydroxyvitamin D (25[OH]D) levels and the risk of multiple sclerosis (MS) in blood samples collected prospectively and during gestation. METHODS: In this nested case-control study, 2 population-based biobanks with 291,500 samples from 164,000 persons collected since 1975 in the northern half of Sweden were used. We identified prospectively collected blood samples from MS cases (n = 192, controls matched 2:1) and gestational samples from pregnant mothers where the offspring had later developed MS (n = 37, control mothers matched 5:1)...
November 20, 2012: Neurology
Stella E Hughes, Tim Spelman, Orla M Gray, Cavit Boz, Maria Trojano, Alessandra Lugaresi, Guillermo Izquierdo, Pierre Duquette, Marc Girard, Francois Grand'Maison, Pierre Grammond, Celia Oreja-Guevara, Raymond Hupperts, Roberto Bergamaschi, Giorgio Giuliani, Jeannette Lechner-Scott, Michael Barnett, Maria Edite Rio, Vincent van Pesch, Maria Pia Amato, Gerardo Iuliano, Mark Slee, Freek Verheul, Edgardo Cristiano, Ricardo Fernández-Bolaños, Dieter Poehlau, Maria Laura Saladino, Norma Deri, Jose Cabrera-Gomez, Norbert Vella, Joseph Herbert, Eli Skromne, Aldo Savino, Cameron Shaw, Fraser Moore, Steve Vucic, Tatjana Petkovska-Boskova, Gavin McDonnell, Stanley Hawkins, Frank Kee, Helmut Butzkueven
BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse. METHODS: An observational case-control study was performed including pregnancies post-MS onset...
May 2014: Multiple Sclerosis: Clinical and Laboratory Research
Goeril Karlsson, Gordon Francis, Gideon Koren, Peter Heining, Xiaoli Zhang, Jeffrey A Cohen, Ludwig Kappos, William Collins
OBJECTIVE: To report outcomes of pregnancies that occurred during the fingolimod clinical development program. METHODS: Pregnancy outcomes from phase II, phase III, and phase IV clinical studies (with optional extensions) were reported by clinical trial investigators. Fingolimod exposure in utero was defined as fingolimod treatment at the time of conception or in the 6 weeks before conception. RESULTS: As of October 31, 2011, 89 pregnancies were reported in completed or ongoing clinical studies, with 74 in fingolimod treatment arms...
February 25, 2014: Neurology
Mia L van der Kop, Mark S Pearce, Leanne Dahlgren, Anne Synnes, Dessa Sadovnick, Ana-Luiza Sayao, Helen Tremlett
OBJECTIVE: To determine (1) whether the risk of adverse neonatal and delivery outcomes differs between mothers with and without multiple sclerosis (MS) and (2) whether risk is differentially associated with clinical factors of MS. METHODS: This retrospective cohort study analyzed data from the British Columbia (BC) MS Clinics' database and the BC Perinatal Database Registry. Comparisons were made between births to women with MS (n = 432) and to a frequency-matched sample of women without MS (n = 2,975) from 1998 to 2009...
July 2011: Annals of Neurology
David H Miller, Franz Fazekas, Xavier Montalban, Stephen C Reingold, Maria Trojano
BACKGROUND: Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors. OBJECTIVES: A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment. METHODS: Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes...
April 2014: Multiple Sclerosis: Clinical and Laboratory Research
Maija Saraste, Saara Väisänen, Anna Alanen, Laura Airas
BACKGROUND: Multiple sclerosis (MS) is a disabling autoimmune disease of the central nervous system, typically affecting women of childbearing years. Although the disease course of MS is highly unpredictable, disease activity is almost invariably halted during pregnancy. After delivery, however, the relapse rate increases. Despite early recognition of this pattern of disease activity, its explanation remains a mystery. OBJECTIVE: The aim of this study was to elucidate the underlying mechanisms responsible for the amelioration of MS during pregnancy and for its reactivation after delivery...
March 2007: Gender Medicine
Sandra Vukusic, Michael Hutchinson, Martine Hours, Thibault Moreau, Patricia Cortinovis-Tourniaire, Patrice Adeleine, Christian Confavreux
The influence of pregnancy in multiple sclerosis has been a matter of controversy for a long time. The Pregnancy in Multiple Sclerosis (PRIMS) study was the first large prospective study which aimed to assess the possible influence of pregnancy and delivery on the clinical course of multiple sclerosis. We report here the 2-year post-partum follow-up and an analysis of clinical factors which might predict the likelihood of a relapse in the 3 months after delivery. The relapse rate in each trimester up to the end of the second year post-partum was compared with that in the pre-pregnancy year...
June 2004: Brain: a Journal of Neurology
C Pozzilli, M Pugliatti
Although pregnancy in women with multiple sclerosis (MS) is not generally considered high risk, there are some associated therapeutic challenges. The pregnancy-associated reduction in the relapse rate, especially in the third trimester, is followed by a sharp increase in the first few months postpartum. Nevertheless, retrospective evidence for pregnant women with and without MS followed for up to 10 years indicates that pregnancy has no perceptible effect on long-term disease course or disability progression...
October 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Riley Bove, Sura Alwan, Jan M Friedman, Kerstin Hellwig, Maria Houtchens, Gideon Koren, Ellen Lu, Thomas F McElrath, Penelope Smyth, Helen Tremlett, A Dessa Sadovnick
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,, 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...
December 2014: Obstetrics and Gynecology
Patricia K Coyle
Multiple sclerosis (MS) is a major neurologic disorder which preferentially affects young women of childbearing age. In the last two decades, a number of disease-modifying therapies have become available to treat relapsing forms of MS. None of these agents is approved for use in pregnancy. The timing of treatment versus conception, and risk of drug pregnancy exposures, are frequent discussion topics when caring for MS patients. This editorial will try to put into context available data, approaches, controversies and future needs...
December 2014: Expert Opinion on Drug Safety
Kerstin Hellwig
BACKGROUND: The incidence of multiple sclerosis (MS) is increasing, particularly in young women (20-40 years). In line, experience in the management of pregnancies and use of disease-modifying therapy (DMT) in women with MS is accumulating. SUMMARY: Fertility is generally not affected in MS. If assisted reproduction techniques (ART) are required, unsuccessful procedures are associated with an increased relapse risk, particularly in the first few months post-ART...
2014: European Neurology
Igor Karp, Alexandra Manganas, Marie-Pierre Sylvestre, Annie Ho, Elaine Roger, Pierre Duquette
PURPOSE: The purpose was to examine the impact of pregnancy on the rates of relapses, progression to irreversible disability, and transition to secondary progressive multiple sclerosis (SPMS) in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: We retrospectively followed two subcohorts of women with RRMS: pregnant (n = 254) and nonpregnant (n = 423). We obtained data on demographic, lifestyle, and clinical characteristics from patient records...
July 2014: Annals of Epidemiology
Ellen Lu, Bing Wei Wang, Colleen Guimond, Anne Synnes, Dessa Sadovnick, Helen Tremlett
OBJECTIVE: To systematically review the literature regarding safety of disease-modifying drug (DMD) use during pregnancy on perinatal and developmental outcomes in offspring of patients with multiple sclerosis (MS). METHODS: A PubMed and EMBASE search up to February 2012 was conducted with a manual search of references from relevant articles. Selected studies were evaluated using internationally accepted criteria. RESULTS: Fifteen studies identified 761 interferon β-, 97 glatiramer acetate-, and 35 natalizumab-exposed pregnancies...
September 11, 2012: Neurology
2015-12-25 18:28:25
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