Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium  

作　　者：Qian Wu Bo Chen Na Liu Yang Hu Chao Pan Ping Zhang Zhou-Ping Tang Bi-Tao Bu 

机构地区：[1]Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China

出　　处：《Chinese Medical Journal》2017年第15期1791-1795,共5页中华医学杂志（英文版）

摘　　要：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.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.

关 键 词：Cesarean Section Inflammatory Demyelinations POSTPARTUM 

分 类 号：S858.28[农业科学—临床兽医学] Q426[农业科学—兽医学]