The influence of pregnancy on multiple sclerosis was studied in 338 women by determining in each trimester of pregnancy and post partum the number of relapses and the corresponding relapse rate. Eighty-five relapses occurred in association with 199 pregnancies, most (65) in the postpartum period, and a low number of relapses (2) were recorded in the last trimester of pregnancy. Comparing the average exacerbation rate of the study group with that of patients with multiple sclerosis in Israel (0.28 relapses per person per year), we found a statistically significant decrease in the third trimester (0.04) and a high increase in the first three months post partum (0.82). This pattern of remissions at the end of pregnancy and exacerbations post partum is similar to that observed in other putative autoimmune diseases.
The influence of pregnancy on multiple sclerosis was studied in 338 women by determining in each trimester of pregnancy and post partum the number of relapses and the corresponding relapse rate. Eighty-five relapses occurred in association with 1 9 pregnancies, most (65) in the postpartum period, and a low number of relapses ( 2 ) were recorded in the last trimester of pregnancy. Comparing the average exacerbation rate of the study group with that of patients with multiple sclerosis in Israel (0.28 relapses per person per year), we found a statistically significant decrease in the third trimester (0.04) and a high increase in the first three months postpartum (0.82). This pattern of remissions at the end of pregnancy and exacerbations post partum is similar to that observed in other putative autoimmune diseases. Our aim in the present study was not just to assess the general influence of pregnancy on MS, but to compare with other MS patients the number of relapses occurring in each trimester of pregnancy and post partum as well as the corresponding relapse rate. The study was undertaken because a number of putative autoimmune diseases show clinical remissions in the second half of pregnancy as well as exacerbations post partum {Sl. Materials and MethodsNationwide studies have been carried out in Israel since 1960 to identify and classify all cases of MS in that country. The National Neurological Disease Registry, maintained by the Uri Leibowitz Neuroepidemiology Unit of the Department of Neurology at Hadassah University Hospital in Jerusalem, was the source of patient records 1131.Criteria for the diagnosis of MS were those used by the Neuroepidemiology Unit, and are a modification of those published by McDonald and Halliday [15}, Bauer [2], and Rose and colleagues { 2 11. Patients were grouped in one of three diagnostic categories: clinically definite, probable, or possible MS. Our study included all clinically definite and probable cases since 1960. In each case we indicated the number and dates of pregnancies, year of onset of the disease, and number and dates of relapses occurring during pregnancy or post partum. A relapse was defined as the appearance of new symptoms in addition to confirmation of new signs or objective evidence of aggravation upon medical neurological examination. The first exacerbation was counted as the onset of the disease. We looked for the relapses occurring during pregnancy and related each relapse to the month of pregnancy during which it occurred. Nine months of pregnancy (divided into three terms) and 6 months of the postpartum course were reviewed. Patients in whom relapses occurred during pregnancy or post partum were followed for an additional 1.5 years after the end of the postpartum period. In those patients we counted the number of relapses occurring from the 15th to the 33rd month, considering the beginning of the pregnancy as the first month.In each period we calculated the relapse rate (number of relapses per person per year) using a x2 test. The denominator was the total ...
The vocational status of 299 multiple sclerosis (MS) patients in Israel, aged 17 to 50 years, was examined. This represents 30 per cent of the MS patients in Israel. It was found that 58 per cent of the patients continued working. Of the remaining 42 per cent, 24 per cent were severely disabled, but 18 per cent had working potential. A comparison was made between patients located up to 1971, and those located between 1971 and 1974. The latter series benefited from earlier follow-up, yielding a population with more recent onset of the illness. They were also younger, and differed from the first series in a number of other social and demographic aspects. The shorter duration and younger age of onset did not affect the percentage working, but did provide a higher percentage with working potential. Higher educational level was associated with continuation of work. Neither type of occupation nor work history had influence in this regard. The severity of the disease, and of some aspects in particular, had a deleterious influence.
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