Epilepsy is the most common neurological disorder requiring medical treatment during pregnancy. However, very few studies are specially dedicated to pregnant women with refractory epilepsy. This study was carried out with the aim of describing obstetrical and neurological outcomes of pregnant women with refractory epilepsy in Brazil. Methods: Pregnant women with refractory epilepsy were enrolled in longitudinal cohort study between January 2005 and January 2018. They were regularly followed by a neurologist until the end of pregnancy. Neurological outcomes included seizure control, status epilepticus and adherence to antiepileptic medications. Obstetrical outcomes included major congenital malformations and obstetrical complications. Results: A total of eighty two patients with a mean age of 24.5 ± 5.5 were included in our study. A significant number of women experienced an increase in seizure frequency and the prevalence of status epilepticus was 8.5%. More than half were non-adherent to antiepileptic drugs. Most of patients required treatment changes during pregnancy, in dose and/or in number of antiepileptic drugs. Cesarean section was the preferred way of delivery and five cases of major congenital malformations were detected. Obstetrical complications were significantly associated with polytherapy, multiple comorbidities, poor adherence to treatment and seizure deterioration during pregnancy (p < 0.05). Conclusions: Women with refractory epilepsy can have a significant risk of obstetric and neurological complications during pregnancy. Treatment of refractory epilepsy in pregnancy is a real challenge for neurologists.

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Background Parsonage–Turner syndrome is an acute peripheral neuropathy that affects the upper brachial plexus region. Previously published reports demonstrate that the condition can be triggered by surgery, infection, autoimmune diseases, strenuous exercise, trauma, radiation, and vaccination. Parsonage–Turner syndrome has already been reported in three other patients who were vaccinated against coronavirus disease 2019. Case presentation We report the case of a 51-year-old Caucasian man without comorbidities who received the first dose of the ChAdOx1-S recombinant vaccine (Vaxzevria, AstraZeneca, Oxford, UK) against coronavirus disease 2019 and was diagnosed with Parsonage–Turner syndrome. A few days after getting vaccinated, the patient reported a progressive increase in pain in the region of vaccine administration. One month later, the shoulder pain was followed by symptoms of hypoesthesia and muscle weakness on abduction and elevation of the left upper limb. Neurological examination revealed an atrophy of the proximal muscles of the left upper limb, accompanied by paresis of the left deltoid, biceps brachii, triceps brachii, and infraspinatus muscles. Electroneuromyography carried out 3 months after the onset of symptoms showed signs consistent with brachial plexus neuritis. The adverse reaction has been properly reported to the Italian Pharmacovigilance System (Italian Medicines Agency—Agenzia Italiana del Farmaco. Conclusion The increased awareness of such association is essential for early identification and diagnosis and, thus, better clinical outcomes.

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ObjectivesTo update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature.DesignScoping review.Data sourcesA comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits.Eligibility criteriaWe included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information.MethodsThis review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings.ResultsThe initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: ‘Changes in work and occupational status due to MS’, ‘work-related socio-economic consequences of MS’, ‘risk factors for unfavourable occupational outcomes’, ‘reported barriers to employment’, ‘reported job accommodations and vocational rehabilitation strategies’, ‘job satisfaction, stigma, and disclosing the diagnosis in the workplace’ and ‘rating clinical scales’.ConclusionsThere are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.

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