Özel durumlarda multipl skleroz'lu hastaya yaklaşım

Translated title of the contribution: Management of multiple sclerosis patients in special conditions

Ayşe Altintaş, Uǧur Uygunoǧlu, Burcu Zeydan, Tülin Coşkun

Research output: Contribution to journalReview articlepeer-review

Abstract

Multiple sclerosis (MS) is an immune mediated chronic inflammatory disease characterized by neuroinflammation and neurodegeneration of the central nervous system (CNS). The course and treatment of the disease are the most common questions asked by patients with MS. Questions concerning the relationship of MS with pregnancy and the postpartum period, assisted reproduction technology, pre and post-operative problems and vaccines are also frequently asked, and some of the answers are still controversial. It is known that MS has no harmful effect on pregnancy or the fetus. The presence of MS is not an indication to terminate pregnancy, and disease progression is not found to be related with pregnancy. The relapses during pregnancy are known to have a mild course but on the contrary, the relapses during the postpartum period tend to be particularly severe. It is suggested to stop taking disease modifying therapies (DMT) at least one month prior to the pregnancy planning period. There is no contraindication for the use of conventional contraceptives; however it is known that oral contraceptives increase the risk of venous thromboembolism in MS patients with impaired mobility. Patients with decreased fertility and who are candidates for assisted reproduction technologies (ART) should be informed about the increased risk of relapse. It is also shown that procedures under spinal anesthesia increase the risk of relapse, so general anesthesia may be an alternative in MS patients. Cautious titration of anesthetic drugs, continuous monitoring and using the lowest possible effective dose are the treatment principles. Except for hepatitis B there are no adequate published data about vaccines that cause CNS demyelination. In this paper, we discuss how to approach the above mentioned particular issues in MS patients.

Translated title of the contributionManagement of multiple sclerosis patients in special conditions
Original languageTurkish
Pages (from-to)77-84
Number of pages8
JournalTurk Noroloji Dergisi
Volume19
Issue number3
DOIs
StatePublished - 2013

Keywords

  • Anesthetics
  • Fertilization
  • Multiple sclerosis
  • Pregnancy
  • Vaccines

ASJC Scopus subject areas

  • Clinical Neurology

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