Family planning considerations in people with multiple sclerosis.

Multiple sclerosis is often diagnosed in patients who are planning on having children. Although multiple sclerosis does not negatively influence most pregnancy outcomes, less is known regarding the effects of fetal exposure to novel disease-modifying therapies (DMTs). The withdrawal of some DMTs during pregnancy can modify the natural history of multiple sclerosis, resulting in a substantial risk of pregnancy-related relapse and disability. Drug labels are typically restrictive and favour fetal safety over maternal safety. Emerging data reporting outcomes in neonates exposed to DMTs in utero and through breastfeeding will allow for more careful and individualised treatment decisions. This emerging research is particularly important to guide decision making in women with high disease activity or who are treated with DMTs associated with risk of discontinuation rebound. As increasing data are generated in this field, periodic updates will be required to provide the most up to date guidance on how best to achieve multiple sclerosis stability during pregnancy and post partum, balanced with fetal and newborn safety.

Guillain-Barré syndrome following different COVID-19 vaccines: a case series.

Background: The COVID-19 vaccine-related Guillain-Barré syndrome (GBS) has been described for both messenger-RNA vaccine and adenovirus-vectored types in a few cases with great public concern and the necessity to inform physicians about the variations of its presentations given its life-threatening consequences. Case presentation: This case series highlighted the presentation with GBS following different COVID-19 vaccinations in seven cases with ages ranging from 29 to 59 years. Three patients received the AstraZeneca vaccine, two received the Pfizer vaccine, one received Sinopharm, and one received the Janssen vaccine. Latency ranged from 5 to 60 days and cases achieved either partial or complete improvement after treatment trials. Patients responded to plasmaphereses, but not pulse steroid therapy. Conclusion: This case series highlights the variable presentations and outcomes of GBS following different COVID-19 vaccination from one center. The early identification and appropriate management of such cases can lead to better outcomes.

Magnetic resonance imaging markers of disability in Egyptian multiple sclerosis patients.

BACKGROUND: The aim of this work was to identify the magnetic resonance imaging (MRI) markers of disability in Egyptian multiple sclerosis (MS) patients. SUBJECTS AND METHODS: This retrospective observational study included 673 patients recruited from the registry of the MS unit at Ain Shams University hospitals. At the time when the MRI scans of the brain and spinal cord were done (with and without gadolinium enhancement), clinical disability was rated using the Expanded Disability Status Scale (EDSS) during the patient's first visit. RESULTS: Females represented 72.5%, all types of MS were included, the mean age of onset was 26.1 ±â€¯7.7(SD) years, mean duration of illness was 8.3 ±â€¯5.5(SD) years. The mean EDSS of the patients was 3.5 ±â€¯2.1. The study population was divided into three groups according to the EDSS score; mild from 0-3 (56.6%), moderate from 3.5-6 (34.9%) and severe more than 6 (8.5%). The number and types of MRI lesions (T2, T1 black holes, T1 contrast and confluent lesions) in the different anatomical locations (periventricular, juxtacortical, infratentorial and spinal) were correlated with the clinical and demographic data of the patients as well as with the EDSS score. The presence of confluent brain lesions (P Ë‚ 0.001), brain T1 hypointense lesions (P = 0.009), and infratentorial T2 lesions (from 1 to 3 lesions (P = 0.04), from 4 to 10 (P ˂ 0.001) and more than 10 (P ˂ 0.001)), were significantly correlated to high EDSS scores after linear regression analysis. CONCLUSION: This is the first Egyptian study to show that infratentorial lesions, confluent brain lesions and T1 hypointense lesions are conventional MRI parameters that correlate with the degree of disability in Egyptian MS patients.

Vitamin D and body mass index in Egyptian multiple sclerosis patients.

BACKGROUND: Vitamin D deficiency and obesity may be related to the pathogenesis and disease activity of multiple sclerosis (MS). This study aimed to assess the correlation between the serum level of 25(OH) vitamin D, body mass index (BMI) and the Expanded Disability Status Scale (EDSS) in a sample of Egyptian MS patients. SUBJECTS AND METHODS: This was an observational study that included 130 MS patients who were recruited consecutively among the patients attending the MS unit of Ain Shams University Hospital, Cairo, in the period between December 2017 and March 2018. The serum level of 25(OH) D, BMI and EDSS were recorded. RESULTS: Females represented 77.7% of the study sample, the mean age was 32.4 ±â€¯8.2 years. MS types were: RRMS 83.1%, SPMS 14.6% and PPMS in 2.3%. Serum level of 25(OH) vitamin D was deficient (less than 10 ng/ml) in 69.2% and insufficient (10-30 ng/ml) in 19.2% of the study population. The mean BMI was 25.5 ±â€¯4.7 kg/m² (classified as overweight). The mean EDSS was 3.5 ±â€¯1.9. The relationship between the EDSS score and 25(OH) D level was inversely correlated, all patients with EDSS ≤ 2 had sufficient levels while all patients with EDSS ≥ 4.5 had deficient levels. High EDSS scores were statistically correlated (p < 0.001) to high BMI and low Log 25(OH) D levels. An inverse correlation was found between the BMI and log 25(OH) D. CONCLUSION: Vitamin D deficiency and overweight are predominant among Egyptian MS patients. The EDSS was positively correlated to the BMI and negatively correlated to 25(OH) D. These factors may possibly play a role in the pathogeneses and progression of MS in Egypt.