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Management of Multiple Sclerosis patient in special conditions [Turk J Neurol]
Turk J Neurol. 2013; 19(3): 77-84 | DOI: 10.4274/Tnd.66487  

Management of Multiple Sclerosis patient in special conditions

Ayşe Altıntaş, Uğur Uygunoğlu, Burcu Zeydan, Tülin Coşkun
Department Of Neurology, Istanbul University Cerrahpasa School Of Medicine, Istanbul, Turkey

Multiplesclerosis (MS) is an immunemediatedchronicinflammatorydiseasecharacterizedbyneuroinflammationandneurodegeneration of thecentralnervoussystem (CNS). Thecourseandtreatment of thediseasearethemostcommonquestionsaskedbypatientswith MS. Questionsconcerningtherelationship of MS withpregnancyandthepostpartumperiod, assistedreproductiontechnology, preand post-operativeproblemsandvaccinesarealsofrequentlyasked, andsome of theanswersarestillcontroversial. It is knownthat MS has noharmfuleffect on pregnancyorthefetus. The presence of MS is not an indicationtoterminatepregnancy, anddiseaseprogression is not foundto be relatedwithpregnancy. Therelapsesduringpregnancyareknowntohave a mildcourse but on thecontrary, therelapsesduringthepostpartumperiodtendto be particularly severe. It is suggestedto stop takingdiseasemodifyingtherapies (DMT) at leastonemonthpriortothepregnancyplanningperiod. There is nocontraindicationfortheuseof conventionalcontraceptives; however it is knownthat oral contraceptivesincreasethe risk of venousthromboembolism in MS patientswithimpairedmobility. Patientswithdecreasedfertilityandwhoarecandidatesforassistedreproductiontechnologies (ART) should be informedabouttheincreased risk of relapse. It is alsoshownthatproceduresunderspinalanesthesiaincreasethe risk of relapse, so general anesthesiamay be an alternative in MS patients. Cautioustitration of anestheticdrugs, continuousmonitoringandusingthelowestpossibleeffectivedosearethetreatmentprinciples. Exceptforhepatitis B therearenoadequatepublished data aboutvaccinesthatcause CNS demyelination. Inthispaper, wediscuss how toapproachtheabovementionedparticularissues in MS patients. (TurkishJournal of Neurology 2013; 19: 77-84)

Keywords: Multiplesclerosis, pregnancy, fertilization, anesthetics, vaccines


Ayşe Altıntaş, Uğur Uygunoğlu, Burcu Zeydan, Tülin Coşkun. Management of Multiple Sclerosis patient in special conditions. Turk J Neurol. 2013; 19(3): 77-84

Corresponding Author: Ayşe Altıntaş, Türkiye


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