High risk of postpartum relapses in neuromyelitis optica spectrum disorder

Klawiter, Eric C.; Bove, Riley; Elsone, Liene; Alvarez, Enríque; Borisow, Nadja; Cortez, Melissa; Mateen, Farrah J.; Mealy, Maureen A.; Sorum, Jaime; Mutch, Kerry; Tobyne, Sean M.; Ruprecht, Klemens; Buckle, Guy J.; Lévy, Michaël; Wingerchuk, Dean M.; Paul, Friedemann; Cross, Anne H.; Jacobs, Anu; Chitnis, Tanuja; Weinshenker, Brian G.

doi:10.1212/wnl.0000000000004681

Cited by 60 publications

(66 citation statements)

References 31 publications

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“…Because interferon beta has been shown to worsen NMOSD disease (Kimbrough et al, 2012) and use of glatiramer acetate has not been shown to affect disease severity (Ayzenberg et al, 2016), patients on these medications were not considered to be treated for their disease. Proximity of relapse to pregnancy was examined in female participants because third trimester and postpartum periods have been associated with relapses (Klawiter et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

Mealy

Cook

Pache

et al. 2018

Multiple Sclerosis and Related Disorders

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The evidence suggests that there may be a risk of vaccination-associated relapses among untreated neuromyelitis optica spectrum disorder patients, however immunosuppressive therapy at time of vaccine may abort the risk; this suggests that the patients who are treated with preventive immune suppression and receive routine vaccinations for common infections may fare better. Further prospective studies are necessary to verify these findings.

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Section: Methodsmentioning

confidence: 99%

Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

Mealy

Cook

Pache

et al. 2018

Multiple Sclerosis and Related Disorders

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“…Current data suggest that the risk for postpartum relapse is increased in women with NMOSD, especially in the first 3–6 months after delivery, and that these relapses are associated with an increase in expanded disability status scale (EDSS). 35 – 39 Due to cessation of immunotherapy, the relapse risk might also be increased during the first trimester of pregnancy. 39 Interestingly, more women than expected were first diagnosed with NMOSD during the first 3 months postpartum.…”

Section: Neuromyelitis Optica Spectrum Disordermentioning

confidence: 99%

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Altıntaş

Dargvainiene

Schneider‐Gold

et al. 2020

Ther Adv Neurol Disord

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Neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis (AE), myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are antibody-mediated neurological diseases. They have mostly female predominance, affecting many women during childbearing age. Interactions between the underlying disease (or necessary treatment) and pregnancy can occur in every of these illnesses. Herein, we present the characteristics of NMOSD, AE, MG and LEMS in general, and review published data regarding the influence of the different diseases on fertility, pregnancy, puerperium, treatment strategy during pregnancy and post-partum period, and menopause but also male factors. We summarise key elements that should be borne in mind when confronted with such cases.

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“…The occurrence of disease relapse increases during the third trimester of gestation and the postpartum period; however, neither epidural anaesthesia during parturition nor breastfeeding exerts adverse effects on NMO . A multicentre study including 217 women with NMOSD showed that the relapse rate of this disease during pregnancy increased, and the postpartum period was a high‐risk factor for the initial presentation of NMOSD . To date, no maternal to foetal transmission of NMO has been reported, most likely due to the low level of AQP4 expression in the foetal central nervous system before the formation of the blood–brain barrier .…”

Section: Nmosd and Pregnancymentioning

confidence: 99%

Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder

Chang

2019

Neuropathology Appl Neurobio

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Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorderNeuromyelitis optica is an autoimmune inflammatory disorder of the central nervous system that preferentially targets the spinal cord and optic nerve. Following the discovery of circulating antibodies against the astrocytic aquaporin 4 (AQP4) water channel protein, recent studies have expanded our knowledge of the unique complexities of the pathogenesis of neuromyelitis optica and its relationship with the immune response. This review describes and summarizes the recent advances in our understanding of the molecular mechanisms underlying neuromyelitis optica disease pathology and examines their potential as therapeutic targets. Additionally, we update the most recent research by proposing major unanswered questions regarding how peripheral AQP4 antibodies are produced and their entry into the central nervous system, the causes of AQP4-IgG-seronegative disease, why peripheral AQP4-expressing organs are spared from damage, and the impact of this disease on pregnancy.

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High risk of postpartum relapses in neuromyelitis optica spectrum disorder

Abstract: The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.

Cited by 60 publications

References 31 publications

Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder

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