scholarly journals Behavioral aspects of nurse practitioners associated with optimal multiple sclerosis care in Spain

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261050
Author(s):  
Gustavo Saposnik ◽  
Beatriz Del Río ◽  
Guillermo Bueno-Gil ◽  
Ángel P. Sempere ◽  
Alejandro Lendínez-Mesa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Nurse Practitioners ◽  
Critical Role ◽  
Behavioral Characteristics ◽  
Limited Information ◽  
Case Scenario ◽  
Occupational Burnout ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean

Background Nurse practitioners (NPs) play a critical role in the multidisciplinary management of patients with multiple sclerosis (MS). Neurologists´ behavioral characteristics have been associated with suboptimal clinical decisions. However, limited information is available on their impact among NPs involved in MS care. The aim of this study was to assess nurses´ therapeutic choices to understand behavioral factors influencing their decision making process. Methods A non-interventional, cross-sectional, web-based study was conducted. NPs actively involved in the care of patients with MS were invited to participate in the study by the Spanish Society of Neurology Nursing. Participants answered questions regarding their standard practice and therapeutic management of seven simulated relapsing-remitting MS (RRMS) case scenarios. A behavioral battery was used to measure participants´ life satisfaction, mood, positive social behaviors, feeling of helpfulness, attitudes toward adoption of evidence-based innovations, occupational burnout, and healthcare-related regret. The outcome of interest was therapeutic inertia (TI), defined as the lack of treatment escalation when there is clinical and radiological evidence of disease activity. A score to quantify TI was created based on the number of simulated scenarios where treatment intensification was warranted. Results Overall, 331 NPs were invited to participate, 130 initiated the study, and 96 (29%) completed the study. The mean age (SD) was 44.6 (9.8) years and 91.7% were female. Seventy-three participants (76.0%) felt their opinions had a significant influence on neurologists´ therapeutic decisions. Sixteen NPs (16.5%) showed severe emotional exhaustion related to work and 13 (13.5%) had depressive symptoms. The mean (SD) TI score was 0.97 (1.1). Fifty-six of NPs showed TI in at least one case scenario. Higher years of nursing experience (p = 0.014), feeling of helpfulness (p = 0.014), positive attitudes toward innovations (p = 0.046), and a higher intensity of care-related regret (p = 0.021) were associated with a lower risk of TI (adjusted R2 = 0.28). Burnout was associated with higher risk of TI (p = 0.001). Conclusions Although NPs cannot prescribe MS treatments in Spain, their behavioral characteristics may influence the management of patients with RRMS. Continuing education and specific strategies for reducing occupational burnout may lead to better management skills and improve MS care.

scholarly journals Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Gustavo Saposnik ◽  
Guillermo Bueno-Gil ◽  
Ángel P. Sempere ◽  
Alfredo Rodríguez-Antigüedad ◽  
Beatriz del Río ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Medical Errors ◽  
Healthcare Professionals ◽  
Expert Panel ◽  
Behavioral Characteristics ◽  
Limited Information ◽  
Occupational Burnout ◽  
Family Expectations ◽  
Standardized Protocol ◽  
Therapeutic Decisions

Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS).Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: “regret and decision,” “regret and physicians,” and “regret and nurses.” An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports—recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty.Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals.Spanish National Register (SL42129-20/598-E).

Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

2020 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Mohammad Enayet Hussain ◽  
Bithi Debnath ◽  
AFM Al Masum Khan ◽  
Md Ferdous Mian ◽  
Md Nahidul Islam ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Diagnosis ◽  
Optic Neuropathy ◽  
Cross Sectional Study ◽  
P Value ◽  
Pattern Reversal ◽  
Cross Sectional ◽  
The Mean ◽  
Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

scholarly journals POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 508.2-509
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Examination ◽  
Demographic Data ◽  
Power Doppler ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

scholarly journals Disease phenotype analyses of relapsing-remitting multiple sclerosis in Canada and Saudi Arabia

2015 ◽  
Vol 42 (S1) ◽  
pp. S32-S32
Author(s):  
M Alluqmani ◽  
M Alqermli ◽  
G Blevins ◽  
B Alotibi ◽  
F Giuliani ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Saudi Arabia ◽  
Geographic Location ◽  
Clinical Findings ◽  
Cross Sectional ◽  
Relapsing Remitting ◽  
Similar Disease ◽  
The Mean ◽  
Sectional Analysis ◽  
Relapsing Remitting Multiple Sclerosis

Background: Multiple sclerosis (MS) exhibits a spectrum of clinical findings, especially in relapsing-remitting MS (RR-MS). To assess the effects of geographic location and ethnicity on RR-MS phenotype, we investigated RR-MS patients in Canada and Saudi Arabia. Methods: A retrospective cross-sectional analysis of patients receiving active care in MS Clinics was performed in Medina, Saudi Arabia and Edmonton, Alberta. Demographic and clinical data was collected for each patient. Results: 98 patients with treated RR-MS were recruited (n=51, Medina; n=47, Edmonton); 40 patients were Caucasian (Edmonton) while 46 patients were Bedouin (Medina). Although the disease duration was longer in the Edmonton (5.7+2.3 yr) compared to the Medina group (4.4+1.4 yr) (p<0.05), the mean age of RR-MS onset, relapse rate and EDSS change were similar. The female:male ratio was comparable in Edmonton (35:12) and Medina (32:19), as was the risk of optic neuritis. The likelihood of an infratentorial lesion-associated presentation differed (Edmonton, n=23; Medina; n=13) among groups (p<0.05). Spinal cord lesions on MRI were more frequent in Edmonton (n=18) compared to Medina (n=1) patients (p<0.05). Conclusions: Despite differences in location, ethnicity, and a predominance of infratentorial lesion burden the Edmonton group, the RR-MS phenotype displayed similar disease severity and trajectory in these cohorts.

scholarly journals Assessing Pharmacists’ Preferences towards Efficacy Attributes of Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 61
Author(s):  
Iciar Martínez-López ◽  
Jorge Maurino ◽  
Patricia Sanmartín-Fenollera ◽  
Ana Ontañon-Nasarre ◽  
Alejandro Santiago-Pérez ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Progression ◽  
Critical Role ◽  
Cross Sectional ◽  
Hospital Pharmacists ◽  
Disease Modifying Therapies ◽  
Hypothetical Treatment ◽  
Related Quality ◽  
Health Related ◽  
Disease Modifying

Introduction: Hospital pharmacists are increasingly playing a critical role in the care of patients with multiple sclerosis (MS). However, little is known about their preferences and perspectives towards different attributes of disease-modifying therapies (DMTs). The objective of this research was to assess pharmacists´ preferences for DMT efficacy attributes. Methods: A multicenter, non-interventional, cross-sectional, web-based study was conducted. Preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition were the attributes selected based on a literature review and a focus group with six hospital pharmacists. Conjoint analysis was used to determine preferences in eight hypothetical treatment scenarios, combining different levels of each attribute and ranking them from most to least preferred. Results: Sixty-five hospital pharmacists completed the study (mean age: 43.5 ± 7.8 years, 63.1% female, mean years of professional experience: 16.1 ± 7.4 years). Participants placed the greatest preference on delaying disease progression (35.7%) and preserving HRQoL (21.6%) and cognition (21.6%). Importance was consistent in all groups of pharmacists stratified according to demographic characteristics, experience, research background, and volume of patients seen per year. Conclusions: Understanding which treatment characteristics are meaningful to hospital pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.

scholarly journals The Serum Level of Midkine in Patients With Multiple Sclerosis and Neuromyelitis Optica

2021 ◽  
Vol 12 (2) ◽  
pp. 199-204
Author(s):  
Milad Moayednia ◽  
◽  
Leila Dehghani ◽  
Amir Safi ◽  
Vahid Shaygannejad ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Growth Factor ◽  
Serum Level ◽  
Neuromyelitis Optica ◽  
Inflammatory Responses ◽  
Neurological Diseases ◽  
Heparin Binding ◽  
Cross Sectional ◽  
Inflammatory Reactions ◽  
The Mean

Introduction: Midkine (MK), a heparin-binding growth factor, is involved in neurological diseases by mediating the inflammatory responses through enhancing the leukocyte migration. The present study assesses the serum concentration of this growth factor among newly developed Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) patients. Methods: The present research, as a cross-sectional study, was performed at Isfahan University of Medical Sciences, Isfahan City, Iran. All samples were selected from patients who visited Kashani and Alzahra hospitals for two years (2014 to 2016). The MK level was assessed in 80 new MS cases, 80 NMO patients, and 80 healthy subjects. After collecting blood sera samples, MK serum level was measured using the ELISA. The obtained data were analyzed in SPSS. Results: The Mean±SD MK level was 1038.58±44.73 pg/mL in the MS group, which was significantly higher than the Mean±SD MK level in the NMO (872.62±55.42 pg/mL) and control groups (605.02±9.42 pg/mL). Conclusion: Overall, these results demonstrated that MK plays a prominent role in inflammatory reactions and neuroautoimmune diseases, especially in MS. So, the MK level may be used for earlier diagnosis and also prevention of disease progression by using a special inhibitor.

scholarly journals Evaluation of Demographic, Clinical and Beyond Clinical Characteristics in Patients with Multiple Sclerosis in Rafsanjan City, Iran

2017 ◽  
Vol 2 (2) ◽  
pp. 63
Author(s):  
Amir Moghaddamahmadi ◽  
Pouria Yazdian-Anari ◽  
Siamak Kazemisufi ◽  
Alireza Vakilian ◽  
Aliasghar Ranjbartotoei ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Mcdonald Criteria ◽  
Male Female Ratio ◽  
The Central Nervous System ◽  
The Mean

Background and objectives: Multiple sclerosis is a chronic and progressive autoimmune disease of the central nervous system that causes motor and sensory impairment and physical disability in patients. This study was conducted to determine the demographic, clinical, and beyond clinical characteristics in patients with multiple sclerosis to help identify common disabilities and better understand of the specific needs of these ones.Materials and methods: This descriptive cross-sectional study was carried out on 50 MS patients in Rafsanjan, Iran. A definitive diagnosis has been done according to neurologist and McDonald criteria. The neurologist conducted examinations. The demographic data were recorded using questionnaire. MRI images were analyzed with the help of radiologist and all data were analyzed using SPSS software.Results: The mean age was 33.81±8.38 years and male/female ratio was 7/42. According to data, 66.7% of the patients were suffering from relapsing-remitting type (RR) disease, and most lesions on MRI in these patients were observed in pyramidal and JuxtaCortical areas. The mean EDSS scores of patients was 1.46. The duration of disease and the number of attacks had a significant correlation with educational level (P<0.05); age was significantly associated with pyramidal, mental and sphincter symptoms (P<0.05).Conclusion: These results suggest that the prevalence of MS in women is higher than in men, especially among housekeeper women. Relapsing and remitting disease showed higher frequency.

scholarly journals The Relationship Between Defense Mechanisms and Nurses’ Occupational Burnout: A Cross-Sectional Study

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Forouzan Elyasi ◽  
Seyed Mohammad Hosseininejad ◽  
Parisa Islami Parkoohi ◽  
Mahsa Kamali ◽  
Marzieh Azizi ◽  
...  
Keyword(s):  
Significant Relationship ◽  
Defense Mechanisms ◽  
Maslach Burnout Inventory ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Occupational Burnout ◽  
Cross Sectional ◽  
Low Level ◽  
The Mean ◽  
The Relationship

Background: Occupational burnout is a psychological syndrome that occurs in response to chronic stress in the workplace. Nowadays, it is known as one of the most important consequences of occupational stress. Defense mechanisms may also affect occupational burnout. Objectives: Since burnout is an important factor influencing the productivity of nurses, this study was conducted to investigate the relationship between the defense mechanisms and occupational burnout among nurses in the educational hospitals of an urban area in Iran. Methods: This descriptive cross-sectional study was conducted on 318 nurses who had at least one-year of work experience in four educational hospitals in Sari city, Iran, in 2018. Sampling was performed using the proportional stratified sampling method. The data were collected by the Maslach Burnout Inventory (MBI) scale, psychological Defense Styles questionnaire (DSQ-40), and a demographic questionnaire. Data were analyzed using descriptive and inferential statistics via the SPSS software V.20. Results: A total of 318 nurses were studied, 13 (4.1%) of the nurses had a burnout. The mean score of the dimension of emotional exhaustion (EE) was 17.49, in the dimension of depersonalization (DP) it was 5.42, and in the dimension of personal achievement (PA) it was 31.58. They indicated a low level of occupational burnout, and the mean scores of FE, DP, and PA subscales indicated a low level of occupational burnout. The use of more mature defense mechanisms had a significant negative correlation with the increase of the EE score (rho = -0.210, P < 0.001), but no significant relationship was reported with other aspects of burnout. Increased use of immature defense mechanisms had a direct correlation with the increase in the score of DP (rho = 0.255 and P < 0.001), but had a significant inverse relationship with the PA score (rho = -0.238 and P < 0.001) and no significant relationship with EE (P = 0.627). No significant relationship was found between the use of neurotic defense mechanisms and burnout dimensions (PEE = 0.119, PDP = 0.174, and PPA = 0.127). Conclusions: Since there is a significant relationship between defense mechanisms and occupational burnout, using the components of defense mechanisms in job interviews can lead to choosing appropriate nurses to perform different tasks in different settings, in accordance with individual and psychological characteristics. Also, teaching problem-solving skills, stress management, and useful information can improve defense mechanisms, nurses’ job performance, and patient satisfaction.

Geographic Distribution of Otolaryngology Advance Practice Providers and Physicians

2021 ◽  
pp. 019459982110404
Author(s):  
Derek H. Liu ◽  
Marshall Ge ◽  
Stephanie Shintani Smith ◽  
Christine Park ◽  
Elisabeth H. Ference
Keyword(s):  
Rural Communities ◽  
Geographic Distribution ◽  
Nurse Practitioners ◽  
Critical Role ◽  
Physician Assistants ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Rural Counties ◽  
Urban Rural ◽  
Future Demands

Objectives Advanced practice providers (APPs), namely physician assistants (PAs) and nurse practitioners (NPs), play an increasing role in meeting growing demands for otolaryngologic services, particularly in rural communities. This study analyzes the geographic distribution of otolaryngology providers, which is essential to addressing future demands. Study Design Cross-sectional study. Setting Medicare Provider Utilization and Payment Data for 2017. Methods Current Procedural Terminology codes were used to identify APPs providing 10 common otolaryngologic services. Geographic distribution was evaluated by calculating densities of APPs and otolaryngologists per 100,000 persons in urban versus rural counties as defined by the National Center for Health Statistics Urban-Rural Classification Scheme. Results We identified cohorts of 8573 otolaryngologists, 1148 NPs, and 895 PAs. There were significantly higher population-controlled densities of otolaryngologists and APPs in urban counties as compared with rural counties. The majority of otolaryngologists (92.1%) and APPs (83.3%) were in urban counties. However, the proportion of APPs (16.7%) in rural counties was significantly higher than the proportion of otolaryngologists (7.9%) in rural counties ( P < .01). A significant majority of rural counties (72.2%) had zero identified providers, and a greater proportion of rural counties (5.0%) were served exclusively by APPs as compared with urban counties (3.2%). Conclusions Although otolaryngologists and APPs mostly practiced in urban counties, a relatively higher proportion of APPs practiced in rural counties when compared with otolaryngology physicians. The majority of rural counties did not have any otolaryngologic providers. Given the expected shortages of otolaryngology physicians, APPs may play a critical role in addressing these gaps in access.

Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era

Neurology ◽  
2018 ◽  
Vol 90 (10) ◽  
pp. e840-e846 ◽  
Author(s):  
Raed Alroughani ◽  
Maryam S. Alowayesh ◽  
Samar F. Ahmed ◽  
Raed Behbehani ◽  
Jasem Al-Hashel
Keyword(s):  
Multiple Sclerosis ◽  
Age At Onset ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Prior Use ◽  
The Mean ◽  
New Treatment ◽  
The Relationship

ObjectiveTo determine the rate of relapse occurrence during pregnancy and postpartum.MethodsIn a cross-sectional study using the national multiple sclerosis (MS) registry, pregnant women with relapsing MS were identified. Data on demographics, clinical characteristics, and disease-modifying therapies (DMTs), including washout periods, were collected. Timings and durations of relapses were extracted. A multivariate logistic regression was used to assess the relationship between relapses and prior use of different DMTs.ResultsCompleted data were available for 99 pregnancies (87 patients). Mean age and mean age at onset were 31.8 ± 5 and 24.4 ± 5.6 years, respectively, while the mean disease duration was 7.4 ± 4.6 years. Most pregnancies (89.9%) occurred in patients who were on DMTs in the year preceding pregnancy with a mean treatment duration of 63.4 ± 29 months. The rates of occurrence of relapses during pregnancy and postpartum were 17.2% and 13.7%, respectively. Most of the relapses occurred during the first (n = 6) and third (n = 7) trimesters. Rate of relapse was highest among patients receiving natalizumab and fingolimod before pregnancy. A longer washout period was significantly associated with relapse occurrence.ConclusionThe relapse occurrence during pregnancy is higher than the previously published rates. The use of high-efficacy therapies with long washout periods before conception was associated with an increased risk of relapses during pregnancy. Postpartum relapse occurrence was similar to that in previous reports.

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