Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study

  • 94 Accesses

  • 46 Citations

Abstract

Acute exacerbations frequently occur after childbirth in patients with relapsing-remitting multiple sclerosis (MS). The present pilot study was initiated in an attempt to reduce the number of childbirth-associated acute exacerbations in the postpartum period. We treated nine MS patients with a history of 12 childbirth-associated acute exacerbations that had occurred 2–9 weeks after previous deliveries. The patients were administered intravenous immunoglobulin (IVIg) at a dose of 0.4 g/kg per day for 5 consecutive days during the 1st week after childbirth and at 6 and 12 weeks there after. None of the treated patients relapsed during the 6-month period after delivery. However, three patients had a remote relapse, two at 8 months and one at 10 months after childbirth, but these probably represented the natural course of disease and were not associated with childbirth. We conclude that IVIg treatment may prevent acute childbirth-associated exacerbations in relapsing-remitting MS patients.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Leibowitz U, Antonovsky A, Kars R, Alter M (1967) Does pregnancy increase the risk of multiple sclerosis? J Neurol Neurosurg Psychiatry 30:354–357

  2. 2.

    Tillman AJB (1950) The effect of pregnancy on multiple sclerosis and its management. Res Publ Assoc Res Nerv Ment Dis 28:548–582

  3. 3.

    Millar JDH, Allison RS, Cheesman EA, Merrett JD (1959) Brain 82:417–426

  4. 4.

    Schapira K, Poskanzer DC, Newell DJ, Miller H (1966) Marriage, pregnancy and multiple sclerosis. Brain 89:419–428

  5. 5.

    Ghezzi A, Caputo D (1981) Pregnancy: a factor influencing the course of multiple sclerosis? Eur Neurol 20:115–117

  6. 6.

    Korn-Lubetzki I, Kahana E, Cooper G, Abramsky O (1984) Activity of multiple sclerosis during pregnancy and puerperium. Ann Neurol 16:228–231

  7. 7.

    Birk K, Ford C, Smeltzer S, Ryan D, Miller R, Rudick RA (1990) The clinical course of multiple sclerosis during pregnancy and the puerperium. Arch Neurol 47:738–742

  8. 8.

    Frith JA, McLeod JG (1988) Pregnancy and multiple sclerosis. J Neurol Neurosurg Psychiatry 51:495–498

  9. 9.

    Bernardi S, Grasso MG, Berollini R, Orzi F, Fieschi C (1991)The influence of pregnancy on relapses in multiple sclerosis: a cohort study. Acta Neurol Scand 84:403–406

  10. 10.

    Nelson LM, Franklin GM, Jones MC (1988) Risk of multiple sclerosis exacerbation during pregnancy and breast feeding. JAMA 259:3441–3443

  11. 11.

    Poser S, Poser W (1983) Multiple sclerosis and gestation. Neurology 33:1422–1427

  12. 12.

    Birk K, Rudick R (1986) Pregnancy and multiple sclerosis. Arch Neurol 43:719–726

  13. 13.

    Achiron A, Margalit R, Hershkoviz R, Markovits D, Reshef T, Melamed E, Cohen IR, Lider O (1994) Intravenous immunoglobulin treatment of experimental T-cell mediated autoimmune diseases: up-regulation of T cell proliferation and down-regulation of TNFα secretion. J Clin Invest 93:600–605

  14. 14.

    Achiron A, Pras E, Gilad R, Ziv I, Mendel M, Gordon CR, Noy S, Sarova-Pinhas I, Melamed E (1992) Open controlled therapeutic trial of high-dose intravenous immunoglobulins in relapsing-remitting multiple sclerosis. Arch Neurol 49:1233–1236

  15. 15.

    Achiron A, Gilad R, Margalit R, Gabbay U, Sarova-Pinhas 1, Cohen IR, Melamed E, Lider O (1995) Gammaglobulin treatment in MS and experimental autoimmune diseases: Delineation of usage and mode of action. J Neurol Neurosurg Psychiatry (in press)

  16. 16.

    Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GE, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

  17. 17.

    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

  18. 18.

    Thornton CA, Ballow M (1993) Safety of intravenous immunoglobulin. Arch Neurol 50:135–136

  19. 19.

    Weisman LE (1994) The safety of intravenous immunoglobulin preparations. Isr J Med Sci 30:459–463

  20. 20.

    Rose LM, Ginsberg AH, Rothstein TL, Ledbetter JA, Clark EA (1988) Fluctuations of CD4+ T-cell subsets in relapsing-remitting multiple sclerosis. Ann Neurol 24:192–199

  21. 21.

    Freedman MS, Antel JP (1988) Immunoregulatory circuits in multiple sclerosis: is there a “short”? Ann Neurol 24:183–184

  22. 22.

    Toyoda M, Zhang X, Petrosian A, Galera OA, Wang SJ, Jordan SC (1994) Modulation of immunoglobulin production and cytokine mRNA expression in peripheral blood mononuclear cells by intravenous immunoglobulin. J Clin Immunol 14:178–189

  23. 23.

    Amran D, Renz H, Lack G, Bradlry K, Gelfand EW (1994) Suppression of cytokine-dependent human T-cell proliferation by intravenous immunoglobulin. Clin Immunol Immunopathol 73:180–186

  24. 24.

    Adachi K, Kumamoto T, Araki S (1989) Interleukin-2 receptor levels indicating relapse in multiple sclerosis. Lancet 1:559–560

  25. 25.

    Trotler JL, Cliford DB, McHinis JE, et al (1989) Correlation of immunological studies and disease progression in chronic progressive multiple sclerosis. Ann Neurol 25:172–178

  26. 26.

    Stagnaro-Green A, Roman SH, Cobin RI, el-Harazy E, Wallenstein S, Davies TF (1992) A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 74:645–653

  27. 27.

    Moncharmont P, Bonnard M, Bernaud J, Rigal D, Mellier G, Monier JC (1992) Study of the immune profile of pregnant women. J Gynecol Obstet Biol Reprod 21:214–218

  28. 28.

    Miotti PG, Liomba G, Dallabetta GA, Hoover DR, Chiphangwi JD, Saah AJ (1992) T lymphocyte subsets during and after pregnancy: analysis in human immunodeficiency virus type 1-infected Malawian mothers. J Infect Dis 165:1116–1119

  29. 29.

    Fishman P, Shoenfeld Y, Hart J, Zigelman R, Shamir Y, Feldberg D, Inbar O, Sredni D, Djaldetti M (1992) Interleukin-3-like activity levels in pregnant women: possible modulation by progesterone. J Reprod Immunol 22:211–216

  30. 30.

    Vanderbeeken YE, Duchateau J, Collet H, Gregoire M, Vandermeersh B, Lucas A (1992) Mechanism of action of maternal serum on the interleukin 2 receptor expression. Immunopharmacol Immunotoxicol 14:491–513

  31. 31.

    Mac Lean MA, Wilson R, Thomson JA, Krishnamurthy S, Walker JJ (1991) Changes in immunologic parameters in normal pregnancy and spontaneous abortion. Am J Obstet Gynecol 165:890–895

  32. 32.

    Opsjln SL, Wathen NC, Tingulstad S, Wiedswang G, Sundan A, Waage A, Austgulen R (1993) Tumor necrosis factor, interleukin-1, and interleukin-6 in normal human pregnancy. Am J Obstet Gynecol 169:397–404

Download references

Author information

Correspondence to A. Achiron.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Achiron, A., Rotstein, Z., Noy, S. et al. Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study. J Neurol 243, 25–28 (1996). https://doi.org/10.1007/BF00878527

Download citation

Key words

  • Multiple sclerosis
  • Pregnancy
  • Intravenous immunoglobulin
  • Exacerbation