Multiple Sclerosis

Multiple Sclerosis • demyelination in the brain and spinal cord, F>M • symptoms depend on the sites: visual disturbances, nystagmus, limb weakness and paresthesias, The legs are affected more than the arms. • Bowel retention and urinary incontinence are frequent complaints. • Involvement of the brain stem can produce diplopia, trigeminal neuralgia, cardiac dysrhythmias, and autonomic dysfunction, while alterations in ventilation can lead to hypoxemia, apnea, and respiratory failure. • As is typical in many immune disorders, pregnancy is associated with an improvement in symptoms, but relapse frequently occurs in the first three postpartum months. • treatment Corticosteroids, immunosuppressants (azathioprine, methotrexate, cyclophosphamide, and cyclosporine) • Symptoms exacerbation with stress (emotional, surgical) ↑ temp, infections Management of Anesthesia • Possible exacerbation post-op • Document neurological symptoms pre-op, re-exam post-op

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the patient should be advised that surgery and anesthesia could produce a relapse despite a well managed anesthetic A→ pseudobulbar palsy→ aspiration risk B→ resp muscle weakness, aspiration C→ autonomic dysfunction → ↑ hypotension with induction D→ steroids (stress dose), immunosuppressants , Sux C/I→ ↑ K CNS → seizure disorder, brain stem involvement (extubate awake), emotional lability → consider pre-med T→ avoid ↑ in temp 0.5 may aggravate symptoms Neuraxial → spinal (avoid), epidural OK mainly for obstetrics, use low doe LA < 0.25% marcaine o Preg→ usually remission, relapse post-partum 1st 3 M