Multiple sclerosis is a disabling, chronic disorder of the central nervous system (brain and spinal cord). Fortunately, it is neither contagious nor directly inherited. For reasons not yet determined, the disorder causes the body’s immune system to attack and damage nerve fibers. The result is interference with the normal transmission of nerve signals in the central nervous system, which affects functions throughout the brain, spinal cord and the body.
Our current knowledge of the disease indicates it is a complex disorder involving interactions between the immune system, genetic predispositions and environmental factors. There are about 2.3 million people worldwide with the disease with estimates of about 400,000 people with MS in the U.S. Women are more affected than men at a ratio of about 2 to 1.
Common symptoms include weakness, numbness, tingling, balance disturbance, vertigo, vision changes, bowel/bladder dysfunction, speech problems and cognitive problems. The diagnosis can be difficult to make, and typically requires symptoms that indicate lesions at different locations in the brain at different times. New brain imaging techniques has made the diagnosis easier, but it still considered a “diagnosis of exclusion” where other causes should be ruled out first.
There are currently a number of treatment options available with more options currently in clinical trials. Early diagnosis is important since early and aggressive treatment of the disease can reduce neurologic deficits and the associated neurologic disability and progression of the disease.
Typical age for the onset of MS is usually during the childbearing years. MS does not affect fertility or the delivery of a baby. We know the number of relapses decreases significantly during pregnancy, particularly in the last two trimesters. However, it is believed undiagnosed MS may be more likely to become symptomatic during pregnancy. Pre-existing deficits such as fatigue, balance disturbance, and bowel/bladder problems can be worsened with pregnancy, especially in the last trimester. In the post-partum period, there is an increase in relapses particularly during the first 3-6 months, as the body returns to it pre-pregnancy hormonal state.
Management of MS is affected with pregnancy. Of the available treatments for MS, a majority have shown adverse fetal effects with use during pregnancy. None of these drugs have been approved for use during pregnancy or breastfeeding.
This means the normal disease modifying agents may not be used by patient during pregnancy based on an individual patient’s decision in discussion with her doctors. Acute therapy medications can still be used in the event of a relapse. It is recommended that pregnant women with MS be closely monitored during pregnancy by both her obstetrician and neurologist.
Menopause can also have an impact on MS. A recent study by Riley M. Bove, MD, from Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, found one third to one half of women reported worsened MS-related symptoms after menopause. Menopause is associated with a decrease in estrogen levels. This raises the possibility that hormone replacement therapy (HRT) may be beneficial in menopausal women with MS, but has not been definitively verified. Some lab studies have shown that estrogen may help decrease MS related inflammatory changes. Recent clinical trials have indicated that estrogen in conjunction with other MS drug therapy can reduce relapses.