Abstract:
Introduction. Multiple sclerosis is an autoimmune disease characterized by chronic inflammation with progressive
demyelination and axonal dysfunction. The disease affects about 1 million young adults, 2/3 of which are women of
childbearing age, with all patients develop irreversible neurological dysfunction. There is observed a stagnation of the
disease during pregnancy, with the return of exacerbations in the postpartum period. Contemporary specialty textbooks
neither confirm nor deny the safety of neuraxial anesthesia in patients with central nervous system diseases.
Clinical case. We present the clinical case of a 25-year-old nullipara pregnant (36 weeks and 6 days gestation age), known
with relapsing-remitting multiple sclerosis and epilepsy. The woman has relapsing multiple sclerosis symptoms during
last 6 days, reason why is urgently consulted by the anesthesiologist for cesarean delivery.
Management and outcome. The article describes the technique of epidural anesthesia for the obstetrical patient with
multiple sclerosis and the course of the perianesthetic evolution, including 1-year follow-up after cesarean section.
Discussions. With the aim of avoiding potential influences on the evolution and progression of the disease, clinical judgment
and the choice of anesthetic technique (general vs. neuraxial) depends on several factors: vaginal delivery or caesarean
section, the presence of contextual clinical modifiers (native or drug-induced coagulopathy, infection), the urgency of the
intervention, and the patient’s cooperation. In case of parturients with multiple sclerosis, all the risks should be rigorously
evaluated: on one hand - the additional risk of general anesthesia (risk of aspiration, potential loss of airway control, critical
desaturations) and on the other hand - the risk of hypothetical local anesthetic toxicity in the case of neuraxial techniques.
Conclusion. Neuraxial epidural anesthesia is a safe technique in obstetric patients with multiple sclerosis.
