Resolution of Acute Disseminated Encephalomyelitis Following Termination of Pregnancy

Kaur, Gagandeep; Neekhra, Aneesh; Houghton, David; Scarff, Jonathan R.; Lippmann, Steven

doi:10.1016/j.psym.2013.05.010

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…Plasmapheresis relieves clinical symptoms by removing harmful circulating antibodies that may cause demyelination ( 8 ). In addition, during pregnancy, patients with ADEM show worsening symptoms, which are relieved after delivery or termination of pregnancy ( 10 ). Similar to previous reports, the patient with ADEM in our study experienced worsened conditions at 3 months of gestation, while plasmapheresis and IVIG therapy relieved clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, the patient's condition repeatedly worsened at 3 months gestion and after the abortion, which indicated that the onset of ADEM in this patient may be related to pregnancy. To date, the common feature of the previous reported pregnancy-related ADEM cases was that their clinical symptoms were exacerbated during pregnancy and improved by plasmapheresis (8)(9)(10)(11)43). Plasmapheresis relieves clinical symptoms by removing harmful circulating antibodies that may cause demyelination (8).…”

Section: Relationship Between Pregnancy-related Dynamic Immune Changes and Acute Disseminated Encephalomyelitis Pathogenesismentioning

confidence: 99%

“…Only a few cases of pregnancy-associated ADEM have been reported, and the underlying mechanism is still unclear (8)(9)(10)(11). Under healthy immune conditions, Th1 and Th2 cytokines are in a state of dynamic balance, thus maintaining normal cellular and humoral immune responses (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between Pregnancy and Acute Disseminated Encephalomyelitis: A Single-Case Study

Deng

Qiu

et al. 2021

Front. Immunol.

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The relationship between pregnancy and autoimmune diseases is unclear. This study investigated the possible role of local immune changes and the activation state of the HMGB1/TLR4/Nf-κB/IL-6 pathway at the maternal–fetal interface during pregnancy in the pathogenesis of acute disseminated encephalomyelitis (ADEM). Clinical data and blood samples of a patient with ADEM were collected to observe the dynamic changes in lymphocyte populations after an abortion. The expression of HMGB1, TLR4, Nf-κB, AQP4, IL-2, IL-4, IL-6, and TNF-α in the fetal membrane and placenta was compared between the patient with pregnancy-related ADEM and a woman with a normal pregnancy using Real-time qPCR and western blotting (WB). The patient was diagnosed with ADEM in the early stage of pregnancy after showing limb weakness symptoms. In the third month of gestation, the symptoms worsened, with a disturbance of consciousness and breathing. After the abortion, the patient relapsed with vertigo and visual rotation. Analysis of lymphocyte subsets by flow cytometry showed that B lymphocytes increased, while natural killer T lymphocytes decreased. WB and Real-time qPCR showed that the expression levels of HMGB1, TLR4, Nf-κB, AQP4, and IL-6 in the fetal membrane and placenta were higher in the patient with pregnancy-related ADEM than in the woman with a normal pregnancy, while those of IL-2 were lower in the patient than in the woman with a normal pregnancy. The local immune changes and the activation of the HMGB1/TLR4/Nf-κB/IL-6 pathway at the maternal–fetal interface may be related to the pathogenesis of ADEM.

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Section: Discussionmentioning

confidence: 99%

Section: Relationship Between Pregnancy-related Dynamic Immune Changes and Acute Disseminated Encephalomyelitis Pathogenesismentioning

confidence: 99%

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Relationship Between Pregnancy and Acute Disseminated Encephalomyelitis: A Single-Case Study

Deng

Qiu

et al. 2021

Front. Immunol.

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“…There was a deterioration in neurological status 2 years after cesarean section at 33 weeks. Kaur et al (105) reported a pregnant patient who was first misdiagnosed with mental illness, for which she was prescribed pharmacotherapy with olanzapine and lorazepam, without any improvement of the symptoms. After being diagnosed with ADEM, she was given intravenous (IV) steroids, IV immunoglobulin (Ig), and plasma exchange, without clinical progress.…”

Section: Adem and Pregnancymentioning

confidence: 99%

Pregnancy-Related Immune Changes and Demyelinating Diseases of the Central Nervous System

Qiu

Chen

et al. 2019

Front. Neurol.

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Demyelinating diseases of the central nervous system comprise a heterogeneous group of autoimmune disorders characterized by myelin loss with relative sparing of axons occurring on a background of inflammation. Some of the most common demyelinating diseases are multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorders. Besides showing clinical, radiological, and histopathological features that complicate their diagnosis, demyelinating diseases often involve different immunological processes that produce distinct inflammatory patterns. Evidence of demyelination diseases derives mostly from animal studies of experimental autoimmune encephalomyelitis (EAE), a model that relies on direct antibody–antigen interactions induced by encephalitogenic T cells. Pregnancy is characterized by non-self-recognition, immunomodulatory changes and an altered Th1/Th2 balance, generally considered a Th2-type immunological state that protects the mother from infections. During pregnancy, the immune response of patients with autoimmune disease complicated with pregnancy is different. Immune tolerance in pregnancy may affect the course of some diseases, which may reach remission or be exacerbated. In this review, we summarize current knowledge on the immune status during pregnancy and discuss the relationship between pregnancy-related immune changes and demyelinating diseases of the central nervous system.

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Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

Vickers

Choi

Eriksson

et al. 2022

Schizophrenia Bulletin

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Background and Hypothesis The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders. Study Design We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14–24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality. Study Results Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention. Conclusion Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women’s health, sexual violence, gender, and sexuality in young people with psychosis.

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Resolution of Acute Disseminated Encephalomyelitis Following Termination of Pregnancy

Cited by 3 publications

References 19 publications

Relationship Between Pregnancy and Acute Disseminated Encephalomyelitis: A Single-Case Study

Relationship Between Pregnancy and Acute Disseminated Encephalomyelitis: A Single-Case Study

Pregnancy-Related Immune Changes and Demyelinating Diseases of the Central Nervous System

Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

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