Multiple sclerosis: Periop mgmt
Clinical - Neurologic
Multiple Sclerosis is an autoimmune disease of inflammation, demyelination, and axonal damage to the central nervous system (Pasternak, 2008; Dorotta, 2002). The disease progression may be subacute with relapses and remissions or chronic and progressive. Treatments include corticosteroids, Interferon-beta, glatiramer acetate, azathioprine, and low-dose mexthotrexate. Although exacerbations can be triggered by physical and emotional stress, exacerbations and remissions often occur unpredictably.
In terms of regional anesthesia, both spinal and epidural anesthesia has been successfully employed in parturients with multiple sclerosis (Perlas, 2005). In some studies, spinal anesthesia has been implicated in postop exacerbations whereas epidural and peripheral nerves blocks have not. One theory is that demyelination of the spinal cord makes it more susceptible to the neurotoxic effects of local anesthetics and the concentration of local anesthetic in the white matter of the spinal cord is higher following a spinal compared to an epidural. There is very little evidence to support or refute the concerns regarding spinal anesthesia (Martucci et al., 2011).
Pasternak, J. and William Lanier (2008). “Diseases Affecting the Brain.” In R. Hines & K. Marschall (Eds.), Stoelting’s Anesthesia and Co-Existing Diseases (p. 230-231) Philadelphia: Churchill Livingstone.