Steroids and MS

[Vaithiar]

Hi,

I have a couple of questions that I need some help with.

(i) I had a case of optic neuritis in my right eye around sept 2008. It resolved by itself. Recent MRI in December revealed that I've hyper-intense signal in my left eye. But it does not vividly bother me at all. My doctor suggests that I take steroids now. Is it the general case? Is it okay to take steroids after 3 months of 1st attack? What side effects does it have?

(ii) I'm not on any DMDs. I am planning to get pregnant soon. Doctor also suggests that I postpone the pregnancy for a couple of years, and get treatment first. Is it normal? Also, he acknowledges that initial phase of pregnancy is a honeymoon period as far as MS is concerned, during 9th and 10th month, it is possible to have serious exacerbations however. I find this very disappointing. I want to have a kid personally. What alternates do I have? Is it okay to go per my plan.

And yes, HAPPY NEW YEAR

Thanks,
Vaithiar

[jimmylegs]

i thought pregnancy related relapses were post partum. as far as i understand it the last trimester is particularly protective. can anyone else back that up?

[lyndacarol]

Vaithiar--Jimmylegs is correct according to many sources I have read. I am not a physician, but your doctor's comments surprise me. Your doctor cannot be an MS specialist or even a neurologist, I think.

Because MS symptoms actually improve during pregnancy, especially during the third trimester, many doctors encourage pregnancy (if it was ever to be considered). I think you have a good plan; maybe you should also plan to look for a more knowledgeable doctor.

[sou]

Hi.

I think I have come across several studies concluding that pregnancy does not seem to affect the outcome of MS at all. In my opinion, disease modifying treatments are not really modifying. I may be wrong, though. I am not a doctor.

Corticosteroids are used for hastening the recovery from relapses, but do not affect their outcome at all, in terms of residual deficits. Most physicians agree that they should not be taken, unless the relapse symptoms heavily interfere with the normal daily activities of the patient. You are the only person that can know if you really need to have a course. Do you have symptoms originating from an ongoing relapse that interfere with your daily living and want to try just in case they are temporarily or slightly reduced?

Use of corticosteroids at such doses used in MS does not come without a cost. They are powerful hormones that are normally produced by the body when under stress. They should be used wisely because they can have nasty consequences. Please, discuss the risks and benefit of such a treatment with your doctor.

sou

[Wonderfulworld]

Hi Viathar
steroids are terrific for some, useless for others. I don't respond to them at all except that they make me grumpy and restless, but another MS-friend finds them really invaluable for occasional use for vision problems she gets during her relapses - they happen her about once every 5 years.

I did a lot of reading before I chose to have my son (best decision I ever made, despite it being hard slog at times with MS). I found this book good for honesty about the issues.
http://www.amazon.com/Multiple-Sclerosi ... 0892817887

This book http://www.mssociety.org.uk/support_and ... ls_15.html is free for download and explains some of the issues around pregnancy.

Personally, I found the second trimester great during pregnancy - months 4-6. Before that I was very nauseous, by month 7 I was in a lot of pain with my back, but I had no MS during the pregnancy.

5-6 months after I gave birth I had a relapse. I breastfed for only 2 weeks and took Copaxone from then on, so I suspect my relapse might have been worse without it in my system.

Obviously the steroids and possible pregnancy are big decisons that only you can make but if your eye is not bothering you I'd be very slow to take steroids. And you will probably have to come off medications to get pregnant anyway so that is another thing to consider.
Best of luck with your decisions.

[Vaithiar]

Thanks for all the replies. That's another thing. I did not start my drug therapy yet. Is it okay to wait for another year hence the concern about pregnancy. Now I get a semi-picture.

Thanks,
Vaithiar

[EyeDoc]

If you are having symptoms from optic neuritis it is an easy recommendation to say yes, take IV steroids. The steroids will help to quiet the inflammation and get you back to normal as soon as possible. If you are symptomless but an MRI suggests inflammation you are in a bit of a grey area. Personally, I would want steroids if I knew there was active inflammation in my optic nerve. I would tell a patient exactly that.

Medicine is not an exact science. People have very strong opinions on whether or not you should take steroids for any given situation. As a patient with MS, my opinion has been transformed to more acceptance of a liberal use of steroids even in cases like yours. I say hit the inflammation hard before vision problems begin or worsen.

[mjs]

If I were you (and I assume you want to have kids), then I would try and get pregnant straight away.

[jimmylegs]

for information (just a general health web site, i haven't gone looking for journal citations to back up all the text here)

Mild cases of zinc deficiency will cause weight loss, some loss of taste and smell, some swelling of the tongue and mouth, slow growth, hair loss, rashes, low sperm count, delayed wound healing and inflammation of the nail bed.

If you are pregnant it is important to take a higher dosage of zinc. Zinc deficiency in the mother has been linked to low birth weight, premature birth and anencephaly (a tragic malformation of the fetus.)

More Severe cases of zinc deficiency will cause a stop in growth and maturation of children, sometimes resulting in a form of dwarfism. Poor testicular functioning can result. There will also be increased problems with the eye such as, optic neuritis, cataract formation, and poor color formation. Zinc deficiency will also lead to immune disorders, and dermatitis.

[Punchy]

Vaithiar, I stopped taking Rebif in order to get pregnant.

My neurologist was over the moon and told me pregnancy is better than any drug. That said, it's been 9 months and I'm still not pregnant, so there is a gamble.

[notasperfectasyou]

Kim had an exaserbation while pregnant and was effectively given a choice. She did not choose the drugs. She came out of the pregnancy much worse then she was going in. Ken