Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS
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Published:2018-03-20
Issue:4
Volume:25
Page:591-600
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ISSN:1352-4585
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Container-title:Multiple Sclerosis Journal
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language:en
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Short-container-title:Mult Scler
Author:
Lavie Caroline1, Rollot Fabien2, Durand-Dubief Françoise1, Marignier Romain3, Ionescu Iuliana1, Casey Romain2, Moreau Thibault4, Tourniaire Patricia5, Hutchinson Michael6, D’Hooghe Marie Béatrice7, Laplaud David-Axel8, Clavelou Pierre9, De Sèze Jérôme10, Debouverie Marc11, Brassat David12, Pelletier Jean13, Lebrun-Frenay Christine14, Le Page Emmanuelle15, Castelnovo Giovanni16, Berger Eric17, Hautecoeur Patrick18, Heinzlef Olivier19, Durelli Luca20, Clerico Marinella20, Trojano Maria21, Patti Francesco22, Vukusic Sandra23ORCID, Alpérovitch A., Carton H., d’Hooghe M.B., Hommes O., Hutchinson M., Adeleine P., Biron A., Cortinovis-Tourniaire P., Grimaud J., Hours M., Moreau T., Vukusic S., Confavreux C., Chauplannaz G., Confavreux C., Cortinovis-Tourniaire P., Grimaud J., Latombe D., Moreau T., Clanet M., Lau G., Rumbach L., Goas J.Y., Rouhart F., Mazingue A., Roullet E., Madigand M., Hautecoeur P., Brunet P., Edan G., Allaire C., Riffault G., Leche J., Benoit T., Simonin C., Ziegler F., Baron J.C., Rivrain Y., Dumas R., Loche D., Bourrin J.C., Huttin B., Delisse B., Gibert I., Boulay C., Verceletto M., Durand G., Bonneviot G., Gil R., Hedreville M.A., Belair C., Poitevin R.J., Devoize J.L., Wyremblewski P., Delestre F., Setiey A., Comi G., Filippi M., Ghezzi A., Martinelli V., Rossi P., Zaffaroni M., Tola M.R., Amato M.P., Fioretti C., Meucci G., Inglese M., Mancardi G.L., Gambi D., Thomas A., Cavazzuti M., Citterio A., Heltberg A., Hansen H.J., Fernandez O., Romero F., Arbizu T., Hernandez J.J., De Andres de Frutos C., Geffner Sclarky D., Aladro Benito Y., Reyes Yanes P., Aguilar M, Burguera J.A., Yaya R., Bonakim Dib W., Arzua-Mouronte D., d’Hooghe M.B., Sindic C.J.M., Carton H., Medaer R., Roose H., Geens K.M.J., Guillaume D., Van Zandycke M., Janssens J., Cornette M., Mol L., Weilbach F., Flachenecker P., Hartung H.P., Haas J., Tendolkar I., Sindrn E., Kölmel H.W., Reichel D., Rauch M., Preuss S., Poser S., Mauch E., Strausser-Fuchs S., Kolleger H., Hawkins S., Howell S.J.L., Rees J.E., Thompson A., Johnson M., Boggild M., Gregory R.P., Bates D., Bone I., Hutchinson M., Polman C., Frequin S., Jongen P., Hommes O., Correia de Sa J., Rio M.E., Huber S., Lechner-Scott J., Kappos L., Ionescu I., Cornu C., Confavreux C., Vukusic S., El-Etr M., Baulieu E.E., El-Etr M., Schumacher M, Ionescu I., Confavreux C., Cornu C., Vukusic S., Hartung H.P., Miller D.H., Hutchinson M., Pugeat M., d’Archangues C., Conard J., Ménard J., Sitruk-Ware R., Pelissier C., Dat S., Belaïsch-Allard J., Athéa N., Büschsenschutz D., Lyon-Caen O., Gonsette R., Boissel J.P., Ffrench P., Durand-Dubief F., Cotton F., Pachai C., Bracoud L., Vukusic S., Ionescu I., Androdias G., Marignier R., Chauplannaz G., Laplaud D.A., Wiertlewski S., Lanctin-Garcia C., Moreau T., Couvreur G., Madinier G., Clavelou P., Taithe F., Aufauvre D., Guy N., Ferrier A., De Sèze J., Collongues N., Debouverie M., Viala F., Brassat D., Gerdelat-Mas A., Henry P., Pelletier J., Rico-Lamy A., Lebrun-Frenay C., Lepage E., Deburghraeve V., Edan G., Castelnovo G., Berger E., Hautecoeur P., Blondiau M., Heinzlef O., Coustans M., Clerc C., Rieu L., Lauxerois M., Hinzelin G., Ouallet J.C., Minier D., Vion P., Gromaire-Fayolle N., Derache N., Thouvenot E., Sallansonnet-Froment M., Tourniaire P., Toureille L., Borgel F., Stankoff B., Grimaud J., Moroianu C., Guennoc A.M., Tournier-Gervason C.L., Peysson S., Trojano M., Patti F., D’Amico E., Motti L., Zaffaroni M., Durelli L., Tavella A.
Affiliation:
1. Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France 2. Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France 3. Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France 4. Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France 5. Service de Neurologie, Centre Hospitalier d’Avignon,
Avignon, France 6. School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland 7. National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium 8. Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France 9. Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France 10. Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France 11. EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France 12. Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France 13. Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France 14. CRCSEP, Department of Neurology, Hôpital Pasteur 2,
Université Côte d’Azur, Nice, France 15. Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France 16. Department of Neurology, CHU de Nîmes, Hôpital Caremeau,
Nîmes, France 17. Department of Neurology, CHU Besançon, Besançon,
France 18. Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France 19. Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France 20. Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy 21. Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy 22. Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy 23. Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
Funder
European Leukodystrophies Association Fondation pour l’Aide à la Recherche sur la Sclérose en Plaques PHRC National
Publisher
SAGE Publications
Subject
Clinical Neurology,Neurology
Cited by
13 articles.
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