Perinatal Management of Neuromyelitis Optica Spectrum Disorder in Pregnancy: A Case Report

Abstract

Purpose: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disease of the central nervous system. Its onset and relapse are closely associated with pregnancy. The aim of this study was to evaluate the risks of NMOSD in the perinatal period.

Patients and methods: A 35-year-old woman, gravida 4, para 1, at 21⁺⁴ weeks of gestation with NMOSD, was managed by a multidisciplinary team.

Results: The patient was diagnosed with NMOSD five years prior to the current pregnancy, following an abortion. She had been treated with pulse steroids and plasma exchange at the time of diagnosis. She had a previous normal full-term delivery. Eight months before the onset of NMOSD, she had an induced abortion. She then experienced a relapse of her condition, complicated by embryonic arrest. During the current pregnancy, she had uneventful antenatal visits and was maintained on corticosteroids and intravenous immunoglobulin (IVIG) with no neurologic sequelae. She gave birth to a healthy male infant and her condition remained stable at follow-up.

Conclusion: Women with NMOSD should consult with both neurologists and obstetricians to reduce the risk of pregnancy-related attacks.

Keywords: abortion; immunosuppression therapy; neuromyelitis optica spectrum disorder; pregnancy.

Figure 1

Initial and relapse MRI enhancement images of the patient. (A) Initial episode: long segmental abnormal signal in the cervical cord (arrow), striated long T1 signal seen from the medulla oblongata to the C7 vertebral level. (B) Relapse: abnormal signal (arrow) of the spinal cord is seen at the level of C2-4.