Posts Tagged 'neurology'

Expecting the Best in Pregnancy and MS

 Pavle Repovic, MD, Ph.D, Neurologist, Multiple Sclerosis, Swedish Neuroscience Institute

Considering that multiple sclerosis (MS) affects primarily women of childbearing age, it comes as no surprise that for many patients MS and pregnancy often occur together. The issues to consider when discussing pregnancy and MS include:

• How pregnancy affects MS

• How MS affects pregnancy

• How MS treatment should be managed throughout pregnancy

The Pregnancy in MS (PRIMS) study of 254 patients revealed that pregnancy is generally protective against MS relapses, in particular during the third trimester. In contrast, the same study found a rebound of relapses during three months post delivery, with 30 percent of women experiencing a relapse within three months after delivery. Several strategies have been proposed to avert the risk of postpartum relapse, including the use of prophylactic IVIG or corticosteroids. More recently, exclusive breast-feeding has been found to offer some protection against postpartum MS activity; however, this finding was disputed in a subsequent study.

There is no evidence that MS impairs fertility or leads to an increased number of spontaneous abortions, stillbirths or congenital malformations. MS also does not increase a woman’s risk of preeclampsia or premature rupture of membranes. Pregnant women with MS are 1.3 times more likely to undergo antenatal hospitalization and to have a Cesarean delivery, and they are 1.7 times more likely to have infants who are small for gestational age 6.

Except for glatiramer acetate, all MS disease-modifying treatments (DMT) have documented in utero harmful effects in animal studies and are therefore FDA pregnancy category C agents. Glatiramer acetate is a category B agent and is not known to have harmful effects in animal studies, although human studies are lacking.

For these reasons, the National MS Society and most MS specialists advise women who intend to become pregnant to discontinue therapy. Given their pharmacokinetics, we suggest the following schedule based on the type of therapy: one month (glatiramer), two months (fingolimod) or three months (interferons, natalizumab) prior to anticipated conception. It is less clear when to resume the therapy following the delivery.

Because only a minuscule amount of medications is excreted in mother’s milk, some MS specialists advise patients to resume therapy – with the exception of fingolimod or natalizumab – as soon as possible, even in women who intend to breast-feed. In the event of an MS relapse during or after the pregnancy, treatment with high dose intravenous methylprednisolone is generally considered safe for both mother and baby.

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Winter Issue of BrainWaves Now Available

The Winter 2010 edition of BrainWaves is now available online.  

BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.

 

Also check out our past editions of the BrainWaves newsletter.

Swedish Expands Radiosurgery Services

There was cause for celebration in the Swedish Radiosurgery Center on Thursday, Dec. 16, as neurosurgeon Ronald Young, M.D. (left), medical director of the Gamma Knife® program, and radiation oncologist Bob Meier, M.D. (below), medical director of the CyberKnife program, treated the center’s first two Gamma Knife patients. The center, formerly known as the Seattle CyberKnife Center, supports both the Swedish Cancer Institute and the Swedish Neuroscience Institute.

The center has offered CyberKnife services since 2006. This year Swedish installed an Elekta Leksell Perfexion Gamma Knife®, making it one of the most advanced stereotactic radiosurgery centers in the country. CyberKnife can be used to treat cancerous and noncancerous tumors in all areas of the body.

At Swedish, Gamma Knife will be used to treat cancer of the brain and some neurological conditions, such as essential tremor, trigeminal neuralgia and arteriovenous malformations. Providing Swedish neurosurgeons and radiation oncologists access to both of these advanced technologies gives them greater flexibility in selecting the best radiation therapy for their patients. For more information, go to www.swedish.org/radiosurgery or call 206-320-7130.

SNI Grand Rounds Series 2010 – Extending the Window for Stroke Therapy: The Role of Imaging

Thursday December 16, 2010
7:30am – 8:30am
Swedish Education and Conference Center, Room B

 Gregory W. Albers, M.D., Professor of Neurology, Stanford University

 

 

 

 

Objectives:

At the conclusion of this session, attendees will have an increased ability to:

  • Discuss options for expanding the treatment window for acute ischemic stroke
  • Review the role of neuroimaging for identification of salvable tissue in stroke patients 
  • Discuss the results of the DEFUSE trial and the study design of the ongoing DEFUSE 2

SNI Grand Round Series is every 1st and 3rd Thursday of each month.

Hot Off the Press!

The Summer 2010 Edition of BrainWaves is now available online. 

BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.

Also check out our past editions of the BrainWaves newsletter.

Defining Tertiary Care for Neurological Diseases

John W. Henson, M.D., FAAN, Director, Neurology, Swedish Neuroscience Institute

 Health care for patients with neurological diseases in the United States occurs across mul­tiple levels, ranging from primary to tertiary care and, less common­ly, quaternary care.

The World Health Organization has defined primary care as the point where first medical contact occurs, and where coordination and continu­ity of medical services is managed. Primary care focuses on a broad range of ser­vices, rather than the diagnosis and treatment of diseases of a specific organ system, and thus primary-care providers (PCPs) have varying levels of comfort in the treatment of neurologi­cal disorders.

Secondary care is provided by specialists, such as general neurologists, who focus on dis­eases affecting a specific organ system, usually upon referral by a PCP. Both primary care and secondary care are provided in an outpatient setting or a general hospital setting.

Tertiary neurological care is provid­ed by subspecialists who treat a subset of conditions that affect the nervous system. Examples include neurologists who specialize in movement disorders and neurosurgeons who operate on brain tumors. Neurological tertiary care is provided in specialized health-care centers where groups of subspecialists from the spectrum of neurological diseases work side by side to offer a multidisciplinary array of diagnostic, and medical and surgical treatment options to patients with advanced cases of common neurological diseases or to those with rare conditions. Quaternary care is a further re­finement of tertiary care that in­cludes research into specific neu­rological diseases.

A major goal of the Swedish Neuroscience Institute is to pro­vide the highest level of tertiary neurological care to patients in the Pacific Northwest. “Eight new providers joined the SNI staff in August of this year,” noted Marc R. Mayberg, M.D., and David W. Newell, M.D., co-executive directors of SNI. “We have added specialty care in neurotology, functional radiosurgery, neuromuscular diseases, neuro­anesthesiology and neuropsychiatry, and we have expanded our existing programs in mul­tiple sclerosis, stroke, pediatric neurosciences, stereotactic and functional neurosurgery, and general neurology.”

In a move towards quaternary care, SNI offers many novel investigational treatments, including a new clinical trial using deep brain stimulation for treatment-resistant depression. SNI is also gaining experience with initiatives to move tertiary care into primary-or second­ary-care settings. These initiatives employ di­rect patient care and virtual care through tele­health to the three million people in the urban Puget Sound area, and to patients throughout the Pacific Northwest.

SNI Sees Major Expansion

Swedish Neuroscience Institute (SNI) is moving forward with plans to increase the availability of tertiary neurological care for patients in the Pacific Northwest. “Eight new providers will join the SNI staff in August,” noted Marc Mayberg, MD, co-director of SNI, “adding specialty care in neuro-otology, functional radiosurgery, and neuropsychiatry, and expanding our existing programs in multiple sclerosis, stroke, neuromuscular disease, pediatric neurology, and general neurology.” An upcoming issue of the SNI newsletter, BrainWaves, will provide more detail about these new providers and programs. Stay tuned for updates.