Activity of multiple sclerosis during pregnancy and puerperium

Korn‐Lubetzki, Isabelle; Kahana, Esther; Cooper, Gerald; Abramsky, Oded

doi:10.1002/ana.410160211

Cited by 152 publications

(43 citation statements)

References 14 publications

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“…Pregnancy also offers protection to female animal models with EAE [15,36,43,61,83]. Specifically, pregnant SJL and C57BL/6 mice showed a disease amelioration compared to non-pregnant controls.…”

Section: Pregnancy In Ms and Eaementioning

confidence: 99%

Neuroprotective effects of estrogens and androgens in CNS inflammation and neurodegeneration

Spence

Voskuhl

2012

Frontiers in Neuroendocrinology

214

162

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Multiple sclerosis (MS) is a disease characterized by inflammation and demyelination. Currently, the cause of MS is unknown. Experimental autoimmune encephalomyelitis (EAE) is the most common mouse model of MS. Treatments with the sex hormones, estrogens and androgens, are capable of offering disease protection during EAE and are currently being used in clinical trials of MS. Beyond endogenous estrogens and androgens, treatments with selective estrogen receptor modulators (SERMs) for estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) are also capable of providing disease protection. This protection includes, but is not limited to, prevention of clinical disease, reduction of CNS inflammation, protection against demyelination, and protection against axonal loss. In EAE, current efforts are focused on using conditional cell specific knockouts of sex hormone receptors to identify the in vivo targets of these estrogens and androgens as well as downstream molecules responsible for disease protection.

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Section: Pregnancy In Ms and Eaementioning

confidence: 99%

Neuroprotective effects of estrogens and androgens in CNS inflammation and neurodegeneration

Spence

Voskuhl

2012

Frontiers in Neuroendocrinology

214

162

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“…The most common anaesthetist’s concern is exacerbation of the pre‐existing deficit after surgery or delivery. However, any stressful condition, fever/hyperpyrexia, infection, surgery, delivery and fatigue may cause exacerbations or relapses, making it very difficult to separate the effects of these factors and anaesthetic techniques or drugs used (34). Pregnancy itself seems to cause partial remission as in other immunological diseases whereas exacerbations are possible up to 3 months after delivery.…”

Section: Sclerotic Diseasementioning

confidence: 99%

Anaesthetic considerations for patients with a pre‐existing neurological deficit: are neuraxial techniques safe?

Vercauteren

Heytens

2007

Acta Anaesthesiol Scand

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Pre-existing neurological and muscular disease may be a specific concern for anaesthetists as they need to consider the effect of anaesthesia upon the disease, vice versa, and the interaction of anaesthesia with the medication taken by the patient. Despite a lack of controlled studies, many anaesthetists, being afraid of a claim, will prefer general rather than regional anaesthesia in these patients. Nevertheless regional anaesthesia certainly merits its place because it offers undeniable advantages. A good pre-operative examination is very important while patients should also be informed about peri-operative implications of anaesthesia, surgery and stress. Paraesthesias, epinephrine and high concentrations of local anaesthetics should be avoided in the majority of the diseases. Some diseases may benefit from epidural anaesthesia while for others a spinal technique may be the technique of preference. Special attention should be paid to patients with spinal stenosis despite recent reassuring reports with respect to safety of regional anaesthetic techniques. Anaesthetists should not automatically take all responsibility in case of progressive or new deficit after the procedure.

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“…Natural course studies in MS have shown that the relapse rate during pregnancy, especially in the third trimester, decreases more than under treatment with currently approved first line treatments interferon-beta or glatiramer acetate. During the first three months post-partum an increase of the relapse rate follows before returning to the pre-pregnancy rate [1]–[3]. In general, the lower relapse rate during pregnancy might be due to a pregnancy-associated down-regulation of cell-mediated immunity.…”

Section: Introductionmentioning

confidence: 97%

Learning from Nature: Pregnancy Changes the Expression of Inflammation-Related Genes in Patients with Multiple Sclerosis

et al. 2010

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BackgroundPregnancy is associated with reduced activity of multiple sclerosis (MS). However, the biological mechanisms underlying this pregnancy-related decrease in disease activity are poorly understood.MethodologyWe conducted a genome-wide transcription analysis in peripheral blood mononuclear cells (PBMCs) from 12 women (7 MS patients and 5 healthy controls) followed during their pregnancy. Samples were obtained before, during (i.e. at the third, sixth, and ninth month of gestation) and after pregnancy. A validation of the expression profiles has been conducted by using the same samples and an independent group of 25 MS patients and 11 healthy controls. Finally, considering the total group of 32 MS patients, we compared expression profiles of patients relapsing during pregnancy (n = 6) with those of relapse-free patients (n = 26).Principal FindingsResults showed an altered expression of 347 transcripts in non-pregnant MS patients with respect to non-pregnant healthy controls. Complementary changes in expression, occurring during pregnancy, reverted the previous imbalance particularly for seven inflammation-related transcripts, i.e. SOCS2, TNFAIP3, NR4A2, CXCR4, POLR2J, FAM49B, and STAG3L1. Longitudinal analysis showed that the overall deregulation of gene expression reverted to “normal” already within the third month of gestation, while in the post-partum gene expressions rebounded to pre-pregnancy levels. Six (18.7%) of the 32 MS patients had a relapse during pregnancy, mostly in the first trimester. The latter showed delayed expression profiles when compared to relapse-free patients: in these patients expression imbalance was reverted later in the pregnancy, i.e. at sixth month.ConclusionsSpecific changes in expression during pregnancy were associated with a decrease in disease activity assessed by occurrence of relapses during pregnancy. Findings might help in understanding the pathogenesis of MS and may provide basis for the development of novel therapeutic strategies.

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Activity of multiple sclerosis during pregnancy and puerperium

Cited by 152 publications

References 14 publications

Neuroprotective effects of estrogens and androgens in CNS inflammation and neurodegeneration

Neuroprotective effects of estrogens and androgens in CNS inflammation and neurodegeneration

Anaesthetic considerations for patients with a pre‐existing neurological deficit: are neuraxial techniques safe?

Learning from Nature: Pregnancy Changes the Expression of Inflammation-Related Genes in Patients with Multiple Sclerosis

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