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Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium

BACKGROUND: Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features o...

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Autores principales: Wu, Qian, Chen, Bo, Liu, Na, Hu, Yang, Pan, Chao, Zhang, Ping, Tang, Zhou-Ping, Bu, Bi-Tao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547830/
https://www.ncbi.nlm.nih.gov/pubmed/28748851
http://dx.doi.org/10.4103/0366-6999.211542
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author Wu, Qian
Chen, Bo
Liu, Na
Hu, Yang
Pan, Chao
Zhang, Ping
Tang, Zhou-Ping
Bu, Bi-Tao
author_facet Wu, Qian
Chen, Bo
Liu, Na
Hu, Yang
Pan, Chao
Zhang, Ping
Tang, Zhou-Ping
Bu, Bi-Tao
author_sort Wu, Qian
collection PubMed
description BACKGROUND: Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium. METHODS: Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied. Records of clinical features, neuroimaging, serum antibodies, cerebrospinal fluid (CSF) findings, annualized relapse rate (ARR), and treatment were analyzed. RESULTS: Among 14 patients, 5 patients were diagnosed with multiple sclerosis (MS), four as neuromyelitis optica (NMO), two as longitudinal extensive transverse myelitis, two as clinical isolated syndrome (CIS), and one as acute brainstem syndrome. All the 14 puerperal female patients presented with more than one manifestation of hemiplegia, paraplegia, uroschesis, visual loss or dysarthria, and with mild to moderate abnormalities of CSF. Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way (n = 10). Median Expanded Disability Status Scale (EDSS) scores were 5.0 (range: 2.0–9.0) at the onset and 2.5 (range: 0–7.0) at the end of follow-ups. Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders (P < 0.05). Median ARR was 0.46 (range: 0–1.16); all patients had a low ARR (0.49 ± 0.34, 95% confidence interval: 0.29–0.69) with standardized treatments. CONCLUSION: Labor-related alterations in the mother's immune system might result in newly-onset demyelinating diseases of central nervous system.
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spelling pubmed-55478302017-08-21 Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium Wu, Qian Chen, Bo Liu, Na Hu, Yang Pan, Chao Zhang, Ping Tang, Zhou-Ping Bu, Bi-Tao Chin Med J (Engl) Original Article BACKGROUND: Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium. METHODS: Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied. Records of clinical features, neuroimaging, serum antibodies, cerebrospinal fluid (CSF) findings, annualized relapse rate (ARR), and treatment were analyzed. RESULTS: Among 14 patients, 5 patients were diagnosed with multiple sclerosis (MS), four as neuromyelitis optica (NMO), two as longitudinal extensive transverse myelitis, two as clinical isolated syndrome (CIS), and one as acute brainstem syndrome. All the 14 puerperal female patients presented with more than one manifestation of hemiplegia, paraplegia, uroschesis, visual loss or dysarthria, and with mild to moderate abnormalities of CSF. Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way (n = 10). Median Expanded Disability Status Scale (EDSS) scores were 5.0 (range: 2.0–9.0) at the onset and 2.5 (range: 0–7.0) at the end of follow-ups. Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders (P < 0.05). Median ARR was 0.46 (range: 0–1.16); all patients had a low ARR (0.49 ± 0.34, 95% confidence interval: 0.29–0.69) with standardized treatments. CONCLUSION: Labor-related alterations in the mother's immune system might result in newly-onset demyelinating diseases of central nervous system. Medknow Publications & Media Pvt Ltd 2017-08-05 /pmc/articles/PMC5547830/ /pubmed/28748851 http://dx.doi.org/10.4103/0366-6999.211542 Text en Copyright: © 2017 Chinese Medical Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Wu, Qian
Chen, Bo
Liu, Na
Hu, Yang
Pan, Chao
Zhang, Ping
Tang, Zhou-Ping
Bu, Bi-Tao
Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title_full Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title_fullStr Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title_full_unstemmed Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title_short Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium
title_sort insights into initial demyelinating episodes of central nervous system during puerperium
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547830/
https://www.ncbi.nlm.nih.gov/pubmed/28748851
http://dx.doi.org/10.4103/0366-6999.211542
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