Epidural Labor Analgesia for a Patient with Neuromyelitis Optica: A Case Report and Review of the Literature

Abstract

Neuromyelitis optica (NMO) is a rare demyelinating disorder affecting the spinal cord and optic nerves. Like multiple sclerosis (MS), it predominantly affects women during childbearing years. The impact of neuraxial anesthesia on the course of NMO is uncertain. There are no large studies available to draw definitive conclusions regarding the safety of neuraxial anesthesia in this population. A review of the current literature suggests that neuraxial anesthesia is unlikely to exacerbate neurologic symptoms in pregnant patients with NMO. However, given the rarity of this disease entity among patients requesting epidural labor analgesia, we recommend taking a cautious approach.

Epidural Anesthesia for Neuromyelitis Optica in Obstetrics: A Case Report and Literature Review

“…On the other hand, there have also been other cases such as ours, reporting the uneventful use of epidural or subarachnoid anesthesia in parturients with pre-existing NMO [8][9][10]. Gunaydin et al performed epidural anesthesia with bupivacaine combined with fentanyl in a 29-year-old paraplegic woman suffering from NMO who was scheduled to undergo a caesarian section and achieved an uncomplicated course of anesthesia [8].…”

“…Gunaydin et al performed epidural anesthesia with bupivacaine combined with fentanyl in a 29-year-old paraplegic woman suffering from NMO who was scheduled to undergo a caesarian section and achieved an uncomplicated course of anesthesia [ 8 ]. Likewise, Chang et al successfully performed epidural anesthesia on a patient with NMO who underwent induction of labor for intrauterine fetal demise (IUFD) with ropivacaine and fentanyl, reporting no exacerbation in her pre-existing neurological symptoms during the postpartum assessment [ 9 ]. Finally, a case of a primigravida undergoing cesarean delivery at 32 weeks of gestation due to an acute exacerbation of NMO was reported by Greene et al, who opted for subarachnoid anesthesia [ 10 ].…”