Management of Multiple Sclerosis patient in special conditions
| Autor: | Ayşe Altıntaş, Uğur Uygunoğlu, Burcu Zeydan, Tülin Coşkun |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: | |
| Zdroj: | Türk Nöroloji Dergisi, Vol 19, Iss 3, Pp 77-84 (2013) |
| Druh dokumentu: | article |
| ISSN: | 1301-062X 1309-2545 |
| DOI: | 10.4274/Tnd.66487 |
| Popis: | 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 |
| Databáze: | Directory of Open Access Journals |
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