management of multiple sclerosis patient in special conditions

management of multiple sclerosis patient in special conditions

;Ayşe Altıntaş;Uğur Uygunoğlu;Burcu Zeydan;Tülin Coşkun
primates; journal of primatology 2013 Vol. 19 pp. 77-84
151
altnta2013trkmanagement

Abstract

Multiplesclerosis (MS) is an immunemediatedchronicinflammatorydiseasecharacterizedbyneuroinflammationandneurodegeneration of thecentralnervoussystem (CNS). Thecourseandtreatment of thediseasearethemostcommonquestionsaskedbypatientswith MS. Questionsconcerningtherelationship of MS withpregnancyandthepostpartumperiod, assistedreproductiontechnology, preand post-operativeproblemsandvaccinesarealsofrequentlyasked, andsome of theanswersarestillcontroversial. It is knownthat MS has noharmfuleffect on pregnancyorthefetus. The presence of MS is not an indicationtoterminatepregnancy, anddiseaseprogression is not foundto be relatedwithpregnancy. Therelapsesduringpregnancyareknowntohave a mildcourse but on thecontrary, therelapsesduringthepostpartumperiodtendto be particularly severe. It is suggestedto stop takingdiseasemodifyingtherapies (DMT) at leastonemonthpriortothepregnancyplanningperiod. There is nocontraindicationfortheuseof conventionalcontraceptives; however it is knownthat oral contraceptivesincreasethe risk of venousthromboembolism in MS patientswithimpairedmobility. Patientswithdecreasedfertilityandwhoarecandidatesforassistedreproductiontechnologies (ART) should be informedabouttheincreased risk of relapse. It is alsoshownthatproceduresunderspinalanesthesiaincreasethe risk of relapse, so general anesthesiamay be an alternative in MS patients. Cautioustitration of anestheticdrugs, continuousmonitoringandusingthelowestpossibleeffectivedosearethetreatmentprinciples. Exceptforhepatitis B therearenoadequatepublished data aboutvaccinesthatcause CNS demyelination. Inthispaper, wediscuss how toapproachtheabovementionedparticularissues in MS patients

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