Pregnancy in Multiple Sclerosis: A Questionnaire Study

<div><p>Background</p><p>Multiple sclerosis (MS) preferentially affects females at childbearing age. For this reason patients and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth.</p><p>Objective</p><p>The aim of this study was to evaluate the expertise about pregnancy related topics in multiple sclerosis of neurologists in private practice.</p><p>Methods</p><p>We developed a survey with 16 multiple choice questions about pregnancy related topics and sent it to neurologists in private practice in Berlin, Germany.</p><p>Results</p><p>56 completed questionnaires were sent back. 54% of all questions were answered correctly, 21% of the questions were answered with “I don’t know”. Correct answers were more often given by physicians who treat more than 400 MS patients per year (p = 0.001). Further positive associations were found for assumed relevance of the topic (p = 0.002) and the degree of counseling (p<0.001).</p><p>Conclusion</p><p>To provide a comprehensive counseling, MS patients with desire for children should be counseled by physicians with a lot of experience in MS treatment.</p></div

Demographic characteristics.

<p>Demographic characteristics.</p

Survey results.

<p>IMT: immunomodulatory therapy.</p

Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.

<p>Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.</p

Clusters showing significant convergence for verum acupuncture points (FDR pN corrected at the cluster level, p<0.05) from ALE meta-analyses.

<p>Clusters showing significant convergence for verum acupuncture points (FDR pN corrected at the cluster level, p<0.05) from ALE meta-analyses.</p

Descriptive analysis of differences due to various methods of acupuncture manipulation.

<p>Words in italics means statistically significant;</p><p>Amyg = Amygdala, ant. = anterior, BA = Brodmann area, BG = basal gyrus, Bil. = bilateral, C = Chinese, Cau = caudate nucleus, Ce = cerebellum, Cing = cingulate, Cing-am = anterior middle cingulate, CingC = cingulate cortex, CingG = cingulate gyrus, CN = China, CO = central operculum, Con. = contralateral, Cun = cuneus, DE = Germany, dlPFC = dorsolateral prefrontal cortex, E = English, EA =  electro-acupuncture, ERRM = even reinforcing and reducing method, Fop = frontal operculum, H = hippocampus, Hyp = hypothalamus, IFG = inferior frontal gyrus, IN = insula, Ipsi = ipsilateral, IPL = inferior parietal lobule, ITG = inferior temporal gyrus, L = left, latS = lateral sulcus, LN = lenticular nucleus, MA =  manual acupuncture, MC = motor cortex, MEFG = medial frontal gyrus, MFG = middle frontal gyrus, MOG = middle occipital gyrus, NA =  information unavailable, Nac = nucleus accumbens, NCT =  non-randomized controlled trial, NRP = nucleus raphe pontis, NSD =  non statistically different, OB = observer blinded, OC = occipital cortex, OG = orbital gyrus, OL = occipital lobe, P = pons, PB =  patient blinded, PFG = prefrontal gyrus, PO = parietal operculum, postCG = postcentral gyrus, preCG = precentral gyrus, preCun = precuneus, PTC = parieto-temporal cortex, Put = putamen, R = right, RCT/P = parallel group randomized trial, RIO =  randomized intervention order, rpm = rotations per minute, SI = primary somatosensory area, SII = second somatosensory area, SMA = supplementary motor area, stimu = stimulation, STG = superior temporal gyrus, supCol = superior colliculi, Th = thalamus, TL = temporal lobe, Tpole = temporal pole, TTG = transverse temporal gyri, V1 = primary visual cortices, Y = yes.</p

Studies included in the ALE meta-analyses.

<p>CS = cutaneous stimulation, CUR = current, EA = electro-acupuncture, ERRM = even reinforcing and reducing method, L = left, MA = manual acupuncture, NAP = non-acupuncture point, R = right.</p

Results from the ALE meta-analyses.

<p>Meta-analyses were performed to evaluate brain response to acupuncture across studies, and contrast verum and sham acupuncture. (A) Brain response to verum acupuncture demonstrated activation in sensorimotor and affective/salience processing brain regions and deactivation in the amygdala and DMN brain regions. (B) Differences in brain response for verum and sham acupuncture from direct contrast showed significance in somatosensory areas, limbic regions, visual processing regions and cerebellum. (C) Brain response to verum and sham acupuncture individually demonstrated activation in sensorimotor and affective/salience processing brain regions and deactivation in the amygdala and DMN brain regions associated with verum acupuncture; while sham acupuncture produced activation in somatosensory regions, affective/salience processing regions, cerebellum and deactivation in limbic regions. (D) Differences in brain response between verum and sham acupuncture from subtraction analysis showed more activation in the sensorimotor affective/cognitive processing brain regions and more deactivation in the amygdala/hippocampal formation for verum acupuncture. For subfigures A–C, p<0.05, cluster level FDR corrected, color bar showed ALE value; for subfigure D, p<0.05, cluster level uncorrected, color bar showed Z value. Amyg: amygdala; Ce: cerebellum; dlPFC: dorsolateral prefrontal cortex; FG: fusiform gyrus; H: hippocampal formation; IN: insula; MCC: middle cingulate cortex; Nac: nucleus accumbens; paraHG: parahippocampal gyrus; PCC: posterior cingulate cortex; preCG: precentral gyrus; pre-SMA: pre-supplementary motor area; SI: primary somatosensory cortex; SII: secondary somatosensory cortex; sgACC: subgenual anterior cingulate cortex; SMG: supramarginal gyrus; Th: thalamus; vmPFC: ventromedial prefrontal cortex.</p

Clusters showing significant convergence for verum versus sham acupuncture (FDR pN corrected at the cluster level, p<0.05) from ALE meta-analyses.

*<p>uncorrected p<0.05.</p

SCORAD differences to baseline at 6, 12, and 36 months, adjusted mean ±95% confidence interval (CI) per group from repeated measures multilevel model with time and time-by-group interaction and fixed effects age, gender, baseline value, TIS-score, social status, expectation of the parents, and random effect physician; post-hoc analysis on complete cases (patients with SCORAD data available for all time points); lower mean values indicate greater improvement.

<p>SCORAD differences to baseline at 6, 12, and 36 months, adjusted mean ±95% confidence interval (CI) per group from repeated measures multilevel model with time and time-by-group interaction and fixed effects age, gender, baseline value, TIS-score, social status, expectation of the parents, and random effect physician; post-hoc analysis on complete cases (patients with SCORAD data available for all time points); lower mean values indicate greater improvement.</p