Further studies are needed to determine the potential risks associated with preconceptional and in utero DMD exposure in patients with MS. Discontinuation of DMDs before conception is still recommended.

No abstract

Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.

The incidence of DMD exposure was relatively low and no cases were intentional. Further studies are needed to ascertain the safety of DMD exposure during pregnancy in MS.

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Objective: To compare the duration of birth hospitalization in mothers with multiple sclerosis (MS) and their newborns relative to the general population and to investigate the impact of MS-related clinical factors on the length of birth hospitalization stays.Methods: Data from the British Columbia Perinatal Database Registry and the British Columbia MS database were linked in this retrospective cohort study. The duration of birth hospitalization in mothers with MS and their newborns (n 5 432) were compared with a frequency-matched sample of the general population (n 5 2,975) from 1998 to 2009. Clinical factors investigated included disease duration and disability, as measured by the Expanded Disability Status Scale. A multivariable model (generalized estimating equations) was used to analyze the association between MS and duration of birth hospitalization, adjusting for factors such as maternal age, diabetes, hypertension, and consecutive births to the same mother. Additional analyses included propensity score matching to further balance cohort characteristics.Results: Compared with the general population, the duration of birth hospitalization was not statistically or clinically different for mothers with MS or their newborns (median differences 5 11.5 and 12.1 hours, respectively; adjusted p . 0.4). Lengths of birth hospitalization were not significantly associated with disease duration (adjusted p . 0.7) or level of disability (adjusted p . 0.5). Findings remained virtually unchanged after propensity score matching.Conclusions: Birth hospitalization has been understudied in women with MS. Contrary to existing studies, we found that MS was not associated with a longer birth hospitalization. This study provides assurance to expectant mothers with MS, their families, and health care providers. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS, often manifesting in women of childbearing age. 1 Fatigue and pelvic organ dysfunction are common, 2 which may cause difficult labor and prolonged birth hospitalization. MS has been associated with a greater risk of difficult labor, 3 assisted vaginal delivery, 3 cesarean delivery, 4 as well as impaired fetal growth and prematurity. [3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. 7-10 However, the durations of birth hospitalization were not examined in these studies. To our knowledge, only 2 studies have examined birth hospitalization in MS 4,11 ; both were from the United States and reported longer hospital stays for mothers with MS 4,11 and their newborns 11 compared with the general population. Prolonged stays can have negative consequences, including an increased risk of hospital-acquired infection as well as creating a strain on scarce health care resources. 12 By linking 2 comprehensive population databases, the British Columbia Multiple Sclerosis (BCMS) database and the British Columbia Perinatal Database Registry (BCPDR), we

The recent approval of several oral disease-modifying drugs (DMDs) for multiple sclerosis (MS) brings promise of improved clinical effectiveness as well as greater drug compliance compared to the existing non-oral DMDs, and substantially increases patient choice and therapeutic options in the effective management of MS. However, for men and women with MS of childbearing age, concerns about the effect of oral DMDs on pregnancy and the fetus may arise. Some limited data from animal reproductive studies of oral DMDs suggest a potential increased risk of early pregnancy loss, impaired growth and birth defects. Although active surveillance mechanisms exist, there is limited data to inform clinical practice. Using existing information from published clinical trials and drug monographs, as well as recent conference proceedings, this review summarizes the mechanism of action (in relation to embryogenesis and pregnancy) and existing animal or human pregnancy-related data for approved (fingolimod, teriflunomide and dimethyl fumarate) and investigational (laquinimod and firategrast) oral DMDs for MS.

592Patients with dementia from multiple pathology often have a combination of Alzheimer's disease (AD) co-existing with Vascular Dementia (VaD) and/or Dementia with Lewy Bodies (DLB). Mixed AD, that is, AD co-existing with other pathology, is increasingly being recognized in clinical practice with an estimated prevalence of over 50% in community-dwelling dementia patients.1-3 AD typically involves marked anterograde amnesia, whereas VaD is often characterized by focal neurological symptoms, abrupt or stepwise progression, executive dysfunction and psychomotor slowing.4 By contrast, DLB is commonly associated with fluctuating cognition with variable attention and alertness, visual perceptual disturbances or hallucinations, and early extrapyramidal symptoms, as well as rapid eye movement (REM) sleep disturbances and neuroleptics sensitivity.5 There are no universally accepted diagnostic criteria Results: Autopsy reports were available for 16/47 (34%) of deceased patients. of these 16 patients, 5 (31%) had pure AD pathology, 10 (63%) had AD with other pathology, and 1 (6%) had non-AD pathology. Compared to patients with pure AD, patients with AD mixed with other pathology had poorer baseline FRs in problem-solving (p<0.01) and community affairs (p<0.02). Conclusion: While the strict enrollment criteria for clinical trials identified the presence of AD pathology in the majority of cases (15/16), multiple pathology was more common than pure AD in our series of autopsied patients. Premortem biomarkers that can distinguish between pure AD and AD with multiple pathology will be beneficial in future clinical trials and dementia patient management. . Parmi ces 16 patients, 5 (31%) avaient une MA pure au point de vue anatomopathologique, 10 (63%) avaient une MA associée à une autre pathologie et 1 (6%) avait une pathologie autre que la MA. Par rapport aux patients atteints d'une MA pure, les patients atteints de la MA associée à une autre pathologie avaient un score à l'ÉEF initiale plus faible pour la résolution de problèmes (p < 0,01) et la participation à la vie communautaire (p < 0,02). Conclusion : Bien que les critères de sélection stricts dans les études cliniques identifiaient la présence de la pathologie de la MA chez la majorité des patients (15/16), la présence de pathologies multiples était plus fréquente que la MA pure à l'autopsie dans cette série de patients. Des biomarqueurs qui peuvent distinguer la MA pure de la MA associée à des pathologies multiples du vivant du patient seront fort utiles pour les études cliniques à venir ainsi que pour le traitement des patients.