SEVERE EXACERBATION OF MULTIPLE SCLEROSIS IN A PATIENT WITH LATE GESTATION – PRESENTATION OF A CLINICAL CASE
https://doi.org/10.34822/2304-9448-2021-3-44-50
Abstract
The study aims to present an analysis of a clinical case of severe exacerbation of multiple sclerosis with a late gestation period in a patient with high disease activity, to assess the possibility of choosing modern methods of treating the disease, taking into account the effectiveness for the mother and the risk for the child. Material and methods. A clinical case of multiple sclerosis is presented: the anamnesis of the disease, the dynamics of symptoms during exacerbation and in its outcome, the therapeutic difficulties of managing the patient during pregnancy and the possibility of controlling the activity of the disease before and during pregnancy as well as after labor are analyzed. Results. Pulse therapy with methyl-prednisone at a dose of 1 000 mg daily, then every other day, in the amount of 7 infusions, followed by intravenous immunoglobulin, allowed to stop a severe exacerbation in a patient with a pregnancy of 34+3 weeks, with a highly active flow of multiple sclerosis, without a response to the drugs used. There were no side effects of treatment at the time of discharge from the hospital. No complications that could be attributed to the side effects of steroid treatment were found in the catamnesis of the mother and the newborn. The worsening of the neurological deficit occurred three months after labor.
About the Authors
L. P. Smertina
Surgut State University;
Surgut Regional Clinical Hospital, Surgut
Russian Federation
Russian Federation
Candidate of Sciences (Medicine), Associate Professor, Department of Cardiology, Medical Institute,
Neurologist
Е-mail: smertina@yandex.ru
A. E. Kasparova
Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk;
Surgut State University, Surgut
Russian Federation
Russian Federation
Doctor of Sciences (Medicine), Associate Professor, Professor, Head, Department of Obstetrics and Gynecology;
Professor, Department of Pathophysiology and General Pathology, Medical Institute
Е-mail: anzkasparova@yandex.ru
References
1. Рассеянный склероз : клинич. рек. URL: https://www. ructrims.org/ (дата обращения: 25.06.2021).
2. Vaughn C., Bushra A., Kolb C., Weinstock-Guttman B. An update on the use of disease-modifying therapy in pregnant patients with multiple sclerosis // CNS Drugs. 2018. Vol. 32, Is. 2. P. 161–178.
3. Завалишин И. А., Пирадов М. А., Бойко А. Н., Никитин С. С., Спирин Н. Н., Переседова А. В. Аутоиммунные заболевания в неврологии. М. : Здоровье человека, 2014. Т. 1. 400 с.
4. Супонева Н. А., Пирадов М. А. Внутривенная иммунотерапия в неврологии. М. : Горячая линия-Телеком, 2013. 312 с.
5. Попова Е. В., Кукель Т. М., Муравин А. И, Бойко А. Н., Мурашко А. В., Гусев Е. И. Ретроспективный анализ течения беременности и родов у женщин с рассеянным склерозом // Рассеянный склероз : журн. неврологии и психиатрии им. С. С. Корсакова. 2013. № 10. С. 52–56.
6. Haas J. High dose IVIG in the post partum period for Prevention of exacerbations in MS // Mult Scler. 2000. Vol. 6, Is. 2. P. 18–20.
7. Мурашко А. В., Муравин А. И., Попова Е. В., Рябов С. А. Анализ течения беременности и родов у женщин с рассеянным склерозом: проспективное исследование // Анналы клинич. и эксперимент. неврологии. 2019. Т. 13, № 4. С. 5–9.
8. Wesselink F. K., Rothman J. J., Hatch E. E., Mikkeisen E. M., Sørensent H. T., Wise L. A. Age and fecundability in a North American preconception cohort study // Am J Obstetrics Gynecol. 2017. Vol. 217, Is. 6. P. 667.e1–667.e8.
9. Nashef L., Marsh M. S., Brex P. Neurology and Pregnancy. Informa, 2012. 280 р.
10. Смертина Л. П., Мовсумов В. З. Опыт применения иммуноглобулина человека нормального (привиджен, CSL Behring) у больных с синдромом Гийена – Барре в условиях неспециализированного неврологического отделения // Сиб. науч. мед. журнал. 2018. Т. 38, № 4. С. 98–104.
11. Fazekas F., Strasser-Fuchs S., Hommes O. R. Intravenous immunoglobulin in MS: promise or failure? // J of the Neurol Sci. 2007. Vol. 259, Is. 1–2. P. 61–66.
12. Thone J., Thiel S., Gold R., Hellwig K. Treatment of multiple sclerosis during pregnancy – safety considerations // ExpertOpinion of Drug Safety. 2017. Vol. 16. P. 523–534.
13. Периоперационное ведение больных с сопутствующими заболеваниями центральной нервной системы : клинич. рек. М., 2016. 28 с.
14. Rieckman P., Toyka K. V., Bassetti C. et al. Escalating immunotherapy of multiple sclerosis: New aspects and practical application // J of Neurology. 2004. Vol. 251. P. 1329–1339.
Review
For citations:
Smertina L.P., Kasparova A.E. SEVERE EXACERBATION OF MULTIPLE SCLEROSIS IN A PATIENT WITH LATE GESTATION – PRESENTATION OF A CLINICAL CASE. Vestnik SurGU. Meditsina. 2021;(3 (49)):44-50. (In Russ.) https://doi.org/10.34822/2304-9448-2021-3-44-50
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