Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability

Importance: Understanding the association between pregnancy and clinical outcomes in women with moderate to severe multiple sclerosis (MS) disability is crucial for guiding family planning and management strategies. Objective: To assess peripregnancy relapse activity and disability progression in women with a preconception Expanded Disability Status Scale (EDSS) score of 3 or higher. Design, Setting, and Participants: This multicenter retrospective cohort study used data from the MSBase Registry, with clinical observations spanning 1984 through 2024. Study cohorts included pregnant women with MS with a preconception EDSS score of 3 or higher (range: 3-10, with higher scores indicating more severe MS-related disability) and propensity score-matched nonpregnant women with MS (controls). Main Outcomes and Measures: The main outcomes were peripregnancy annualized relapse rates (ARRs) and time to 6-month confirmed disability worsening (CDW). Results: A total of 1631 women with MS were included, of whom 575 were in the pregnant cohort (median [IQR] age at pregnancy, 32.5 [29.1-36.1] years) and 1056 were in the nonpregnant cohort (median [IQR] age, 32.6 [27.5-37.2] years). The median (range) preconception EDSS score was 3.5 (3.0-7.5). Relapse activity decreased during pregnancy, with a 75% reduction in ARR during the first trimester (rate ratio [RR], 0.25; 95% CI, 0.15-0.43), and increased to 36% above preconception levels in the first 3 months post partum (RR, 1.36; 95% CI, 1.06-1.75). Relapse during pregnancy was associated with a higher preconception ARR (odds ratio [OR], 1.56; 95% CI, 1.10-2.20) and preconception use of natalizumab (OR, 4.42; 95% CI, 1.24-23.57) or fingolimod (OR, 14.07; 95% CI, 2.81-91.30). Older age (OR, 0.92; 95% CI, 0.85-0.99) and continuation of disease-modifying therapy into pregnancy (OR, 0.42; 95% CI, 0.19-1.00) were associated with reduced risk. Disease-modifying therapy reinitiation within 1 month post partum was associated with lower odds of early postpartum relapse (OR, 0.45; 95% CI, 0.23-0.86). There was no significant difference in time to CDW between the pregnant and nonpregnant groups (hazard ratio [HR], 1.15; 95% CI, 0.96-1.38). However, ARR during pregnancy (HR, 1.37; 95% CI, 1.13-1.65) and postpartum EDSS score higher than 4 (HR, 2.69; 95% CI, 1.80-4.03) were associated with shorter time to CDW. Conclusions and Relevance: In this cohort study, women with moderate to severe MS disability exhibited a pattern of peripregnancy relapse activity similar to that reported in women with less disability. Pregnancy was not associated with worse long-term disability outcomes, although optimizing disease control in the peripregnancy period remained critical

STRESS MOTHER EXPERIENCE FOR PREMATURE BIRTH

The main objective of this study is to approach the experience of these mothers in our Moroccan context by focusing on the analysis of the socio-cultural impact. The secondary objective is to determine the risk factors associated with feelings of psychological difficulties.&#x0D; This study was conducted at the Souissi Maternity Hospital in Rabat over the six months. We chose to conduct a survey of Moroccan women who gave birth to premature alive. Preterm birth was defined as any birth prior to 37 weeks of amenorrhea (SA). This is a prospective, descriptive and analytical study. 100 parturients were included in our study.&#x0D; The collection of information has been on the second day of delivery. Two groups of women were subsequently identified:&#x0D; &#x0D; group A with one or two light feelings (absent or mild psychological difficulty)&#x0D; group B with 3 or 4 medium or strong feelings (medium to strong psychological difficulty).&#x0D; &#x0D; We analyzed two groups to determine the risk factors associated with psychological difficulties.&#x0D; In univariate analysis, we examined the association of each of maternal and neonatal characteristics with both groups A and B.&#x0D; Nine factors were significantly associated with moderate or intense psychological difficulty.&#x0D; A high level of instruction, well-monitored pregnancy, presence of a pathological obstetrical history and cesarean delivery, all these factors accentuate the intensity of the feelings experienced.&#x0D; In parallel, a weight greater than or equal to 1500 g birth of the child, transfer the baby in neonatal medicine lessen these feelings.&#x0D; In multivariate analysis and after adjusting for factors studied, only the presence of pathological factors obstetrical history and the place of the child in the parental project are significant and therefore correlated with average or intense psychological difficulty.&#x0D; We have indeed found that prematurity inscribed the child and his mother in a difficult context. This would affect preterm rupture of the mother / child bond. After that other questions have emerged. Given that self-efficacy is rooted in the failures and successes encountered previously, it would have been interesting to consider primiparity of the mother, and the support of the father at birth and after, when returning home because it would play a leading role and would have a positive impact on the mother's psyche.</jats:p

Acute longitudinally extensive transverse myelitis: A case report

Introduction: Acute Longitudinally Extensive Transverse Myelitis (ALETM) poses a problem of etiological diagnosis. The etiologies are diverse; infectious, degenerative, inflammatory and auto-immune. Case report: We are presenting the case of a 19 years old patient, with no prior medical history. He presented with acute flaccid paraplegia, urinary retention and fecal incontinence. The magnetic resonance imaging concluded to ALETM and the etiological investigation allowed us to confirm the diagnosis of myelitis inaugurating systemic lupus erythematosus. The treatment was based on the association of corticoids, cyclophosphamides and four plasma exchanges. No real improvement in the neurological deficiency was noted. Conclusion: The lupus origin of ALETM, although rare, should be considered in young patients since it could, as in our case, the diagnostic circumstance of systemic lupus erythematosus. Keywords: myelitis; lupus erythematosus; systemic; paraplegia.</jats:p

Primary oral tuberculosis in an immunocompetent patient

Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment. Keywords: Tuberculosis; oral; immunocompetence; ulcer.</jats:p

Progressive Multifocal Leukoencephalopathy Treated by Immune Checkpoint Inhibitors

International audienceObjective: Our aim was to assess the real-world effectiveness of immune checkpoint inhibitors for treatment of patients with progressive multifocal leukoencephalopathy (PML).Methods: We conducted a multicenter survey compiling retrospective data from 79 PML patients, including 38 published cases and 41 unpublished cases, who received immune checkpoint inhibitors as add-on to standard of care. One-year follow-up data were analyzed to determine clinical outcomes and safety profile. Logistic regression was used to identify variables associated with 1-year survival.Results: Predisposing conditions included hematological malignancy (n = 38, 48.1%), primary immunodeficiency (n = 14, 17.7%), human immunodeficiency virus/acquired immunodeficiency syndrome (n = 12, 15.2%), inflammatory disease (n = 8, 10.1%), neoplasm (n = 5, 6.3%), and transplantation (n = 2, 2.5%). Pembrolizumab was most commonly used (n = 53, 67.1%). One-year survival was 51.9% (41/79). PML-immune reconstitution inflammatory syndrome (IRIS) was reported in 15 of 79 patients (19%). Pretreatment expression of programmed cell death-1 on circulating T cells did not differ between survivors and nonsurvivors. Development of contrast enhancement on follow-up magnetic resonance imaging at least once during follow-up (OR = 3.16, 95% confidence interval = 1.20-8.72, p = 0.02) was associated with 1-year survival. Cerebrospinal fluid JC polyomavirus DNA load decreased significantly by 1-month follow-up in survivors compared to nonsurvivors (p < 0.0001). Thirty-two adverse events occurred among 24 of 79 patients (30.4%), and led to treatment discontinuation in 7 of 24 patients (29.1%).Interpretation: In this noncontrolled retrospective study of patients with PML who were treated with immune checkpoint inhibitors, mortality remains high. Development of inflammatory features or overt PML-IRIS was commonly observed. This study highlights that use of immune checkpoint inhibitors should be strictly personalized toward characteristics of the individual PML patient. ANN NEUROL 2023;93:257-270