Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO.

Background Although several papers report on pregnancy and multiple sclerosis (MS), no systematic review of the literature has been carried out. Neurologists and obstetricians need to have proper information to discuss with women presenting with MS who consider pregnancy.Objectives Literature review and meta-analysis of data on pregnancy in women with MS.Search strategy The present work followed the recommendations of the PRISMA Statement. Using the PICO framework, the authors independently searched for the terms 'pregnancy' OR 'gestation' OR 'pregnant' AND 'multiple sclerosis' OR 'MS' in the following databases: EMBASE/Excerpta Medica, Medline, Pubmed, Scopus, Index Medicus, Biomed Central, Ebsco Fulltext, LILACS, Scielo and the Cochrane Database of Systematic Reviews. Selection criteria: only papers presenting original work with analysis of at least one of the outcomes among pregnant women with MS were included.Data collection and analysis Two independent workers performed the literature review. All the authors selected and read the relevant papers. Two other authors summarised data for analysis.Main results Twenty-two papers reporting on 13 144 women with MS and their pregnancies were analysed. A significant decrease in relapse rate was observed during pregnancy, followed by a significant increase after delivery. Miscarriages, low birthweight, prematurity, neonatal death and malformations were assessed among these women and their offspring. There seems to be a regional influence on the rates of caesarean sections and abortions among women with MS. Neonatal death and malformation rates did not seem to be particularly high.Authors' conclusions The present work provides evidence-based data that can be discussed with women with MS and their relatives when pregnancy is considered by these families.Keywords Meta-analysis, multiple sclerosis, pregnancy, systematic review.Please cite this paper as: Finkelsztejn A, Brooks J, Paschoal F, Fragoso Y. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG 2011;118:790-797.

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We assessed the efficacy and safety of oral single doses of 0.5 and 1 g metamizol vs. 1 g acetylsalicylic acid (ASA) in 417 patients with moderate episodic tension-type headache included in a randomized, double-blind, placebo- and active-controlled, parallel, multicentre trial. Eligibility criteria included 18-65 years of age, history of at least two episodes of tension-type headache per month in the 3 months prior to enrollment, and successful previous pain relief with a non-opioid analgesic. Treatment arms were metamizol 0.5 g (n = 102), metamizol 1 g (n = 108), ASA 1 g (n = 102) and placebo (n = 105). The analgesic efficacy of 0.5 and 1 g metamizol vs. placebo was highly statistically significant (alpha: 0.025; one-sided) for sum of pain intensity differences, maximum pain intensity difference, number of patients with at least 50% pain reduction, time to 50% pain reduction, maximum pain relief and total pain relief. A trend towards an earlier onset of a more profound pain relief of 0.5 and 1 g metamizol over 1 g ASA was noticed. All medications including placebo were almost equally safe and well tolerated.

No deleterious effects from glatiramer acetate were observed in these pregnant women with MS or in their offspring. No increment in postnatal relapse rate was observed. However, the use of glatiramer acetate during pregnancy should be restricted to the most difficult cases, in which the benefits clearly outweigh the risks.

Although uncommon, severe depression with suicide ideation or attempts may be observed during treatment of MS with IFN-beta. This association should not discourage the use of this drug, but physicians need to be aware of this possible adverse event from IFN-beta.

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MIDAS translated to Brazilian Portuguese was a useful tool for identifying severe cases of migraine and of transformed migraine in a working environment. The workers did not consider MIDAS to be difficult to answer. Their high level of voluntary participation demonstrates that this medical condition was of real interest among the workers, whether they were sufferers or not.