Menopause signals a major shift in hormonal levels in women and causes a variety of symptoms that can overlap and/or interact with those related to multiple sclerosis (MS). These symptoms can have considerable impact on the quality of life for many women living with MS. Menopause remains a largely unexplored period for women with MS and there are only a few studies that have attempted to investigate the potential effect that menopause may have on the clinical course of MS, including inflammatory activity and disability progression. However, the limitations of these studies, including small sample size and lack of controlling for confounding factors, such as aging and disease duration, undermine the reliability of their results. Larger longitudinal cohort studies are required to draw robust conclusions on whether menopause impacts the course of MS. It is important that clinicians facilitate open discussions around both MS and menopausal symptoms, given the potential considerable overlap many women are likely to experience. Understanding how to recognise and appropriately manage menopausal symptoms can have a major impact on the quality of life of the individual.
The use of high-efficacy disease-modifying therapies (DMTs) early in the course of multiple sclerosis (MS) has been shown to improve clinical outcomes and is becoming an increasingly popular treatment strategy. As a result, monoclonal antibodies, including natalizumab, alemtuzumab, ocrelizumab, ofatumumab, and ublituximab, are frequently used for the treatment of MS in women of childbearing age. To date, only limited evidence is available on the use of these DMTs in pregnancy. We aim to provide an updated overview of the mechanisms of action, risks of exposure and treatment withdrawal, and pre-conception counseling and management during pregnancy and post-partum of monoclonal antibodies in women with MS. Discussing treatment options and family planning with women of childbearing age is essential before commencing a DMT in order to make the most suitable choice for each individual patient.
Hyperosmolar hyperglycemic state (HHS), a life-threatening complication of diabetes mellitus, may initially manifest with a broad spectrum of neurological symptoms. These include encephalopathy, coma, chorea-hemiballismus and epileptic activity. Focal motor seizures are among the most common manifestations whilst aphasia has rarely been described so far. Based on a recent experience from our hospital, we herein report a rare case of a patient with nonketotic hyperglycemia-induced global aphasia, followed by focal motor seizures and attempt a comprehensive review of the literature with regards to the various neurological syndromes through which, undiagnosed diabetes and HHS may present. Neurological aspects of HHS are not so well-documented and are certainly under-represented in the literature.
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