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Multiple sclerosis: basic knowledge and new insights in perioperative management

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Abstract

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system affecting young adults that may lead to significant disability. The clinical course varies among the types of the disease as well as among individuals. Herein we provide a brief review of the recent data concerning the clinical presentation, diagnosis, causes, and pathogenesis of MS as well as medication used, followed by the anesthetic considerations of patients diagnosed with the disease. To accomplish this, we conducted a systematic PubMed literature search for articles, using the terms multiple sclerosis, anesthesia, general, regional, perioperative, and preoperative, and we then manually reviewed the references from each pertinent article. Because randomized controlled trials on the field are rare, most information is derived by case reports and case series. We concluded that the disease itself as well as the treatment modalities may have several implications in the conduct of anesthesia and perioperative management of MS patients. General and regional anesthetic techniques have been successfully used. With thorough preoperative evaluation and in depth knowledge of the disease and its complications, the MS patients can be managed safely.

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References

  1. Charcot JM. Histologie de la sclerose en plaques. Gazette des Hopitaux. 1868;41:554–5.

    Google Scholar 

  2. Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372:1502–17.

    PubMed  CAS  Google Scholar 

  3. Rosati G. The prevalence of multiple sclerosis in the world: an update. Neurol Sci. 2001;22:117–39.

    PubMed  CAS  Google Scholar 

  4. Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol. 2010;9:520–32.

    PubMed  Google Scholar 

  5. Confavreux C, Vukusic S. Age at disability milestones in multiple sclerosis. Brain. 2006;129:595–605.

    PubMed  Google Scholar 

  6. Manouchehrinia A, Constantinescu CS. Cost-effectiveness of disease-modifying therapies in multiple sclerosis. Curr Neurol Neurosci Rep. 2012;12:592–600.

    PubMed  Google Scholar 

  7. Tremlett H, Zhao Y, Devonshire V. Natural history comparisons of primary and secondary progressive multiple sclerosis reveals differences and similarities. J Neurol. 2009;256:374–81.

    PubMed  Google Scholar 

  8. Stuke K, Flachenecker P, Zettl UK, Elias WG, Freidel M, Haas J, Pitschnau-Michel D, Schimrigk S, Rieckmann P. Symptomatology of MS: results from the German MS Registry. J Neurol. 2009;256:1932–5.

    PubMed  Google Scholar 

  9. Olek MJ. Epidemiology and clinical features of multiple sclerosis in adults. In: Basow DS, editor. UpToDate. Waltham: UpToDate; 2012.

    Google Scholar 

  10. Steens A, Heersema DJ, Maurits NM, Renken RJ, Zijdewind I. Mechanisms underlying muscle fatigue differ between multiple sclerosis patients and controls: a combined electrophysiological and neuroimaging study. Neuroimage. 2012;59:3110–8.

    PubMed  CAS  Google Scholar 

  11. Skokou M, Soubasi E, Gourzis P. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. ISRN Neurol. 2012;2012:427102.

    PubMed Central  PubMed  Google Scholar 

  12. Truini A, Barbanti P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. J Neurol. 2013;260:351–67.

    PubMed Central  PubMed  CAS  Google Scholar 

  13. Al-Araji AH, Oger J. Reappraisal of Lhermitte’s sign in multiple sclerosis. Mult Scler. 2005;11:398–402.

    PubMed  Google Scholar 

  14. Buchter B, Dunkel M, Li J. Multiple sclerosis: a disease of affluence? Neuroepidemiology. 2012;39:51–6.

    PubMed  Google Scholar 

  15. Santiago O, Gutierrez J, Sorlozano A, de Dios Luna J, Villegas E, Fernandez O. Relation between Epstein–Barr virus and multiple sclerosis: analytic study of scientific production. Eur J Clin Microbiol Infect Dis. 2010;29:857–66.

    PubMed  CAS  Google Scholar 

  16. Lang HL, Jacobsen H, Ikemizu S, Andersson C, Harlos K, Madsen L, Hjorth P, Sondergaard L, Svejgaard A, Wucherpfennig K, Stuart DI, Bell JI, Jones EY, Fugger L. A functional and structural basis for TCR cross-reactivity in multiple sclerosis. Nat Immunol. 2002;3:940–3.

    PubMed  CAS  Google Scholar 

  17. Mikaeloff Y, Caridade G, Tardieu M, Suissa S. Parental smoking at home and the risk of childhood-onset multiple sclerosis in children. Brain. 2007;130:2589–95.

    PubMed  Google Scholar 

  18. Pierrot-Deseilligny C. Clinical implications of a possible role of vitamin D in multiple sclerosis. J Neurol. 2009;256:1468–79.

    PubMed Central  PubMed  CAS  Google Scholar 

  19. International Multiple Sclerosis Genetics Consortium; Wellcome Trust Case Control Consortium 2. Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis. Nature (Lond) 2011;476:214–219.

    Google Scholar 

  20. Goodin DS. The causal cascade to multiple sclerosis: a model for MS pathogenesis. PLoS ONE. 2009;4:e4565.

    PubMed Central  PubMed  Google Scholar 

  21. Hedström AK, Hillert J, Olsson T, Alfredsson L. Exposure to anaesthetic agents does not affect multiple sclerosis risk. Eur J Neurol. 2013;20:735–9.

    PubMed  Google Scholar 

  22. Gandhi R, Laroni A, Weiner HL. Role of the innate immune system in the pathogenesis of multiple sclerosis. J Neuroimmunol. 2009;221:7–14.

    Google Scholar 

  23. Loma I, Heyman R. Multiple sclerosis: pathogenesis and treatment. Curr Neuropharmacol. 2011;9:409–16.

    PubMed Central  PubMed  CAS  Google Scholar 

  24. Flensner G, Ek AC, Söderhamn O, Landtblom AM. Sensitivity to heat in MS patients: a factor strongly influencing symptomology. An explorative survey. BMC Neurol. 2011;11:27.

    PubMed Central  PubMed  Google Scholar 

  25. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69:292–302.

    PubMed Central  PubMed  Google Scholar 

  26. Tsang BK, Macdonell R. Multiple sclerosis: diagnosis, management and prognosis. Aust Fam Phys. 2011;40:948–55.

    Google Scholar 

  27. Río J, Comabella M, Montalban X. Multiple sclerosis: current treatment algorithms. Curr Opin Neurol. 2011;24:230–7.

    PubMed  Google Scholar 

  28. Sorensen PS, Ross C, Clemmesen KM, Bendtzen K, Frederiksen JL, Jensen K, Kristensen O, Petersen T, Rasmussen S, Ravnborg M, Stenager E, Koch-Henriksen N, Danish Multiple Sclerosis Study Group. Clinical importance of neutralizing antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis. Lancet. 2003;362:1184–91.

    PubMed  CAS  Google Scholar 

  29. Schmied M, Duda PW, Krieger JI, Trollmo C, Hafler DA. In vitro evidence that subcutaneous administration of glatiramer acetate induces hyporesponsive T cells in patients with multiple sclerosis. Clin Immunol. 2003;106:163–74.

    PubMed  CAS  Google Scholar 

  30. Harrison DM, Gladstone DE, Hammond E, Cheng J, Jones RJ, Brodsky RA, Kerr D, McArthur JC, Kaplin A. Treatment of relapsing-remitting multiple sclerosis with high-dose cyclophosphamide induction followed by glatiramer acetate maintenance. Mult Scler. 2012;18:202–9.

    PubMed Central  PubMed  CAS  Google Scholar 

  31. Fazekas F, Lublin FD, Li D, Freedman MS, Hartung HP, Rieckmann P, Sørensen PS, Maas-Enriquez M, Sommerauer B, Hanna K, PRIVIG Study Group, UBC MS/MRI Research Group. Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Neurology. 2008;71:265–71.

    PubMed  CAS  Google Scholar 

  32. Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence-based guideline update: plasmapheresis in neurologic disorders. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011;76:294–300.

    PubMed Central  PubMed  CAS  Google Scholar 

  33. King AM, Menke NB, Katz KD, Pizon AF. 4-Aminopyridine toxicity: a case report and review of the literature. J Med Toxicol. 2012;8:314–21.

    PubMed Central  PubMed  Google Scholar 

  34. Le Page E, Leray E, Taurin G, Coustans M, Chaperon J, Morrissey SP, Edan G. Mitoxantrone as induction treatment in aggressive relapsing remitting multiple sclerosis: treatment response factors in a 5 year follow-up observational study of 100 consecutive patients. J Neurol Neurosurg Psychiatry. 2008;79:52–6.

    PubMed  Google Scholar 

  35. Kheder A, Nair KP. Spasticity: pathophysiology, evaluation and management. Pract Neurol. 2012;12:289–98.

    PubMed  Google Scholar 

  36. Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013;260:984–97.

    PubMed  CAS  Google Scholar 

  37. Rossi S, editor. Australian medicines handbook. Adelaide: Australian Medicines Handbook; 2011.

    Google Scholar 

  38. Tremlett HL, Yoshida EM, Oger J. Liver injury associated with the beta-interferons for MS: a comparison between the three products. Neurology. 2004;62:628–31.

    PubMed  CAS  Google Scholar 

  39. Racke M, Lovett-Racke A, Krandikar N. The mechanism of action of glatiramer acetate treatment in multiple sclerosis. Neurology. 2010;74:S25–30.

    PubMed  CAS  Google Scholar 

  40. Dahdaleh D, Altmann DM, Malik O, Nicholas RS. Breathlessness, night sweats, and weight loss on natalizumab. Lancet. 2012;380:726–7.

    PubMed  CAS  Google Scholar 

  41. Cohen JA, Barkhof F, Comi G, Hartung HP, Khatri BO, Montalban X, Pelletier J, Capra R, Gallo P, Izquierdo G, Tiel-Wilck K, de Vera A, Jin J, Stites T, Wu S, Aradhye S, Kappos L, TRANSFORMS Study Group. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15.

    PubMed  CAS  Google Scholar 

  42. Mitchell G. An update on multiple sclerosis therapy. Med Clin N Am. 1993;77:231–49.

    PubMed  CAS  Google Scholar 

  43. Wonsiewicz MJ, Melvin S. Neurologic syndromes and disorders with their anesthetic implications. In: Albin MS, editor. Textbook of neuroanesthesia: with neurosurgical and neuroscience perspectives. New York: McGraw-Hill; 1996. p. 421–6.

    Google Scholar 

  44. Nicholson G, Burrin JM, Hall GM. Peri-operative steroid supplementation. Anaesthesia. 1998;53:1091–104.

    PubMed  CAS  Google Scholar 

  45. Orange JS, Hossny EM, Weiler CR, Ballow M, Berger M, Bonilla FA, Buckley R, Chinen J, El-Gamal Y, Mazer BD, Nelson RP Jr, Patel DD, Secord E, Sorensen RU, Wasserman RL, Cunningham-Rundles C, Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2006;117:S525–53.

    PubMed  CAS  Google Scholar 

  46. Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher. 2007;22:270–6.

    PubMed  Google Scholar 

  47. Havla JB, Pellkofer HL, Meinl I, Gerdes LA, Hohlfeld R, Kümpfel T. Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment. Arch Neurol. 2012;69:262–4.

    PubMed  Google Scholar 

  48. O’Connor PW, Goodman A, Kappos L, Lublin FD, Miller DH, Polman C, Rudick RA, Aschenbach W, Lucas N. Disease activity return during natalizumab treatment interruption in patients with multiple sclerosis. Neurology. 2011;76:1858–65.

    PubMed  Google Scholar 

  49. Siger M, Durko A, Nicpan A, Konarska M, Grudziecka M, Selmaj K. Discontinuation of interferon beta therapy in multiple sclerosis patients with high pre-treatment disease activity leads to prompt return to previous disease activity. J Neurol Sci. 2011;303:50–2.

    PubMed  Google Scholar 

  50. Mutluay FK, Gurses HN, Saip S. Effects of multiple sclerosis on respiratory functions. Clin Rehabil. 2005;19:426–32.

    PubMed  CAS  Google Scholar 

  51. Altintas A, Demir T, Ikitimur HD, Yildirim N. Pulmonary function in multiple sclerosis without any respiratory complaints. Clin Neurol Neurosurg. 2007;109:242–6.

    PubMed  Google Scholar 

  52. Grasso MG, Lubich S, Guidi L, Rinnenburger D, Paolucci S. Cerebellar deficit and respiratory impairment: a strong association in multiple sclerosis? Acta Neurol Scand. 2000;101:98–103.

    PubMed  CAS  Google Scholar 

  53. Carvalho SR, Alvarenga Filho H, Papais-Alvarenga RM, Chacur FH, Dias RM. Is it useful to perform carbon monoxide diffusion capacity and respiratory muscle function tests in patients with multiple sclerosis without disability? Respirology. 2012;17:869–75.

    PubMed  Google Scholar 

  54. Smeltzer SC, Skurnick JH, Troiano R, Cook SD, Duran W, Lavietes MH. Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function. Chest. 1992;101:479–84.

    PubMed  CAS  Google Scholar 

  55. Tantucci C, Massucci M, Piperno R, Betti L, Grassi V, Sorbini CA. Control of breathing and respiratory muscle strength in patients with multiple sclerosis. Chest. 1994;105:1163–70.

    PubMed  CAS  Google Scholar 

  56. Caminero A, Bartolomé M. Sleep disturbances in multiple sclerosis. J Neurol Sci. 2011;309:86–91.

    PubMed  Google Scholar 

  57. Ferini-Strambi L, Filippi M, Martinelli V, Oldani A, Rovaris M, Zucconi M, Comi G, Smirne S. Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings. J Neurol Sci. 1994;125:194–7.

    PubMed  CAS  Google Scholar 

  58. Brass SD, Duquette P, Proulx-Therrien J, Auerbach S. Sleep disorders in patients with multiple sclerosis. Sleep Med Rev. 2010;14:121–9.

    PubMed  Google Scholar 

  59. De Hert S, Imberger G, Carlisle J, Diemunsch P, Fritsch G, Moppett I, Solca M, Staender S, Wappler F, Smith A, Task Force on Preoperative Evaluation of the Adult Noncardiac Surgery Patient of the European Society of Anaesthesiology. Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:684–722.

    PubMed  Google Scholar 

  60. Culley DJ, Crosby G. Neurologic disease and anesthesia. In: Cotrell JE, Smith S, editors. Anesthesia and neurosurgery. St. Louis: Mosby; 2001. p. 617–8.

    Google Scholar 

  61. Lensch E, Jost WH. Autonomic disorders in multiple sclerosis. Autoimmune Dis. 2011;2011:803841.

    PubMed Central  PubMed  CAS  Google Scholar 

  62. Flachenecker P, Reiners K, Krauser M, Wolf A, Toyka KV. Autonomic dysfunction in multiple sclerosis is related to disease activity and progression of disability. Mult Scler. 2001;7:327–34.

    PubMed  CAS  Google Scholar 

  63. Merico A, Piccione F, Levedianos G, Vescovo G, Tonin P. Autonomic and cardiac testing in multiple sclerosis patients complaining of fatigue during rehabilitative treatment. Basic Appl Myol. 2005;15:87–92.

    Google Scholar 

  64. Uhthoff W. Untersuchungen uber die bei der multiplen Herdsklerose vorkommenden Augenstorungen. Arch Psychiatr Nervenkr. 1889;20:55.

    Google Scholar 

  65. Martinez-Rodriguez JE, Munteis E, Roquer J. Periodic hyperthermia and abnormal circadian temperature rhythm in a patient with multiple sclerosis. Mult Scler. 2006;12:515–7.

    PubMed  CAS  Google Scholar 

  66. Yamashita K, Yokoyama T, Tokai H, Imazu Y, Lee M, Manabe M. Anesthetic management for a patient with multiple sclerosis at exacerbation stage under general anesthesia. Masui. 2003;52:521–3.

    PubMed  Google Scholar 

  67. Inoue S, Furuya H. Sevoflurane is safe for anesthetic management in patients with multiple sclerosis. Acta Anaesthesiol Taiwan. 2006;44:187–9.

    PubMed  Google Scholar 

  68. Kono Y, Ueda N, Kano T. Anesthetic management for a patient with multiple sclerosis. Masui. 2005;54:906–8.

    PubMed  Google Scholar 

  69. Takano E, Serita R, Hotta M, Yumura J, Ouchi T, Koitabashi T. An anesthetic case of a patient with multiple sclerosis and supranuclear palsy. Masui. 2010;59:906–10.

    PubMed  Google Scholar 

  70. Lee KH, Park JS, Lee SI, Kim JY, Kim KT, Choi WJ, Kim JW. Anesthetic management of the emergency laparotomy for a patient with multiple sclerosis. A case report. Korean J Anesthesiol. 2010;59:359–62.

    PubMed Central  PubMed  CAS  Google Scholar 

  71. Kulkarni LM, Sanikop C, Shilpa H, Vinayan A. Anaesthetic management in a patient with multiple sclerosis. Indian J Anaesth. 2011;55:64–7.

    PubMed Central  PubMed  Google Scholar 

  72. Briggs ED, Kirsch JR. Anesthetic implications of neuromuscular disease. J Anesth. 2003;17:177–85.

    PubMed  Google Scholar 

  73. Sahin L, Korkmaz HF, Sahin M, Aydin T, Toker S, Gulcan E. Desflurane anaesthesia in a patient with multiple sclerosis in total hip replacement. Arch Med Sci. 2010;6:984–6.

    PubMed Central  PubMed  Google Scholar 

  74. Ceyhan A, Uyar ET, Gencay IY, Gunal SE. Anesthesia in multiple sclerosis and obstructive sleep apnea: case report and literature review. J Res Med Sci. 2011;16:828–35.

    PubMed Central  PubMed  CAS  Google Scholar 

  75. Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth. 2008;101:557–62.

    PubMed  CAS  Google Scholar 

  76. Anand S, Bhatia A, Rajkumar, Sapra H, Gupta V, Mehta Y. Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: an observational study. Saudi J Anaesth 2012;6:358–362.

  77. Martyn JA, White DA, Gronert GA, Jaffe RS, Ward JM. Up-and-down regulation of skeletal muscle acetylcholine receptors. Effects on neuromuscular blockers. Anesthesiology. 1992;76:822–43.

    PubMed  CAS  Google Scholar 

  78. Kyttä J, Rosenberg PH. Anaesthesia for patients with multiple sclerosis. Ann Chir Gynaecol. 1984;73:299–303.

    PubMed  Google Scholar 

  79. Cooperman LH. Succinylcholine-induced hyperkalemia in neuromuscular disease. JAMA. 1970;213:1867–71.

    PubMed  CAS  Google Scholar 

  80. Levine M, Brown DF. Succinylcholine-induced hyperkalemia in a patient with multiple sclerosis. J Emerg Med. 2012;43:279–82.

    PubMed  Google Scholar 

  81. Jaffe RS, Gronert GA, Fleming NW, Antognini JF. Neuromuscular disorders and muscle relaxants. In: Cucchiara RF, Black S, Michenfelder JD, editors. Clinical neuroanesthesia. 2nd ed. Edinburgh: Churchill Livingstone; 1998. p. 456–7.

    Google Scholar 

  82. Zhou J, Allen PD, Pessah IN, Naguib M. Neuromuscular disorders and malignant hyperthermia. In: Miller RD, editor. Miller’s anesthesia. 7th ed. Edinburgh: Churchill Livingstone; 2009. p. 1172.

    Google Scholar 

  83. Schneider KM. AANA journal course: update for nurse anesthetists: an overview of multiple sclerosis and implications for anesthesia. AANA J. 2005;73:217–24.

    PubMed  Google Scholar 

  84. Brett RS, Schmidt JH, Gage JS, Schartel SA, Poppers PJ. Measurement of acetylcholine receptor concentration in skeletal muscle from a patient with multiple sclerosis and resistance to atracurium. Anesthesiology. 1987;66:837–9.

    PubMed  CAS  Google Scholar 

  85. Venkatraghavan L, Manninen P. Anesthesia for deep brain stimulation. Curr Opin Anaesthesiol. 2011;24:495–9.

    PubMed  Google Scholar 

  86. Venkatraghavan L, Luciano M, Manninen P. Review article: anesthetic management of patients undergoing deep brain stimulator insertion. Anesth Analg. 2010;110:1138–45.

    PubMed  Google Scholar 

  87. Leiknes KA, Jarosh von Schweder L, Høie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2012;2:283–344.

  88. Fitzsimons MG, Welch CA, Haspel KL, Gorman JM. The safety and efficacy of ECT and anesthesia in the setting of multiple sclerosis. J Psychiatr Pract. 2007;13:195–8.

    PubMed  Google Scholar 

  89. Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002;94:1351–64.

    PubMed  Google Scholar 

  90. Szuba MP, Guze BH, Baxter LR. Electroconvulsive therapy increases circadian amplitude and lowers core body temperature in depressed subjects. Biol Psychiatry. 1997;42:1130–7.

    PubMed  CAS  Google Scholar 

  91. Weber F, Rüdel R, Aulkemeyer P, Brinkmeier H. The endogenous pentapeptide QYNAD induces acute conduction block in the isolated rat sciatic nerve. Neurosci Lett. 2002;317:33–6.

    PubMed  CAS  Google Scholar 

  92. Brinkmeier H, Aulkemeyer P, Wollinsky KH, Rüdel R. An endogenous pentapeptide acting as a sodium channel blocker in inflammatory autoimmune disorders of the central nervous system. Nat Med. 2000;6:808–11.

    PubMed  CAS  Google Scholar 

  93. Bouchard P, Caillet JB, Monnet F, Banssillon V. Spinal anesthesia and multiple sclerosis. Ann Fr Anesth Reanim. 1984;3:194–8.

    PubMed  CAS  Google Scholar 

  94. Hebl JR, Horlocker TT, Schroeder DR. Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg. 2006;103:223–8.

    PubMed  Google Scholar 

  95. Warren TM, Datta S, Ostheimer GW. Lumbar epidural anesthesia in a patient with multiple sclerosis. Anesth Analg. 1982;61:1022–3.

    PubMed  CAS  Google Scholar 

  96. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339:285–91.

    PubMed  CAS  Google Scholar 

  97. Vukusic S, Confavreux C. Multiple sclerosis and pregnancy. Rev Neurol. 2006;162:299–309.

    PubMed  CAS  Google Scholar 

  98. Nelson LM, Franklin GM, Jones MC. Risk of multiple sclerosis exacerbation during pregnancy and breast-feeding. JAMA. 1988;259:3441–3.

    PubMed  CAS  Google Scholar 

  99. Dalmas AF, Texier C, Ducloy-Bouthors AS, Krivosic-Horber R. Obstetrical analgesia and anaesthesia in multiple sclerosis. Ann Fr Anesth Reanim. 2003;22:861–4.

    PubMed  Google Scholar 

  100. Bader AM, Hunt CO, Datta S, Naulty JS, Ostheimer GW. Anesthesia for the obstetric patient with multiple sclerosis. J Clin Anesth. 1988;1:21–4.

    PubMed  CAS  Google Scholar 

  101. Lirk P, Birmingham B, Hogan Q. Regional anesthesia in patients with preexisting neuropathy. Int Anesthesiol Clin. 2011;49:144–65.

    PubMed  Google Scholar 

  102. Vercauteren M, Heytens L. Anaesthetic considerations for patients with a pre-existing neurological deficit: are neuraxial techniques safe? Acta Anaesthesiol Scand. 2007;51:831–8.

    PubMed  CAS  Google Scholar 

  103. Dorotta IR, Schubert A. Multiple sclerosis and anesthetic implications. Curr Opin Anaesthesiol. 2002;15:365–70.

    PubMed  Google Scholar 

  104. D’hooghe MB, Nagels G, Bissay V, De Keyser J. Modifiable factors influencing relapses and disability in multiple sclerosis. Mult Scler. 2010;16:773–85.

    PubMed  Google Scholar 

  105. Wang A, Sinatra RS. Epidural anesthesia for cesarean section in a patient with von Hippel–Lindau disease and multiple sclerosis. Anesth Analg. 1999;88:1083–4.

    PubMed  CAS  Google Scholar 

  106. Perlas A, Chan VW. Neuraxial anesthesia and multiple sclerosis. Can J Anaesth. 2005;52:454–8.

    PubMed  Google Scholar 

  107. Levesque P, Marsepoil T, Ho P, Venutolo F, Lesouef JM. Multiple sclerosis disclosed by spinal anesthesia. Ann Fr Anesth Reanim. 1988;7:68–70.

    PubMed  CAS  Google Scholar 

  108. Rabadán Díaz JV, López Moreno JA, Soria Quiles A, Del Pino Moreno AL. Neurological deficit during recovery from cesarean section under spinal anesthesia after the appearance of undiagnosed multiple sclerosis. Rev Esp Anestesiol Reanim 2006;53:673–674

  109. Sakurai M, Kanazawa I. Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaine and mexiletine. J Neurol Sci. 1999;162:162–8.

    PubMed  CAS  Google Scholar 

  110. Berger JM, Ontell R. Intrathecal morphine in conjunction with a combined spinal and general anesthetic in a patient with multiple sclerosis. Anesthesiology. 1987;66:400–2.

    PubMed  CAS  Google Scholar 

  111. Martucci G, Di Lorenzo A, Polito F, Acampa L. A 12-month follow-up for neurological complication after subarachnoid anesthesia in a parturient affected by multiple sclerosis. Eur Rev Med Pharmacol Sci. 2011;15:458–60.

    PubMed  CAS  Google Scholar 

  112. Alvarez JI, Cayrol R, Prat A. Disruption of central nervous system barriers in multiple sclerosis. Biochim Biophys Acta. 2011;1812:252–64.

    PubMed  CAS  Google Scholar 

  113. Drake E, Drake M, Bird J, Russell R. Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience. Int J Obstet Anesth. 2006;15:115–23.

    PubMed  CAS  Google Scholar 

  114. Sakurai M, Mannen T, Kanazawa I, Tanabe H. Lidocaine unmasks silent demyelinative lesions in multiple sclerosis. Neurology. 1992;42:2088–93.

    PubMed  CAS  Google Scholar 

  115. Koeva V, Bar-Or A, Gendron D, Backman SB. Epidural blood patch in a patient with multiple sclerosis: is it safe? Can J Anaesth. 2013;60:479–83.

    PubMed  Google Scholar 

  116. Dawson JW. The histology of disseminated sclerosis. Trans R Soc Edinb. 1916;50:517–725.

    Google Scholar 

  117. Boerio D, Creange A, Hogrel JY, Lefaucheur JP. Alteration of motor nerve recovery cycle in multiple sclerosis. Clin Neurophysiol. 2007;118:1753–8.

    PubMed  Google Scholar 

  118. Antonini G, Millefiorini E, Borsellino G, Morino S, Rasura M, Pozzilli C. Subclinical peripheral nervous system involvement in multiple sclerosis. Muscle Nerve. 1995;18:1216–7.

    PubMed  CAS  Google Scholar 

  119. Poser CM. The peripheral nervous system in multiple sclerosis. A review and pathogenetic hypothesis. J Neurol Sci. 1987;79:83–90.

    PubMed  CAS  Google Scholar 

  120. Ng K, Howells J, Pollard JD, Burke D. Up-regulation of slow K(+) channels in peripheral motor axons: a transcriptional channelopathy in multiple sclerosis. Brain. 2008;131:3062–71.

    PubMed  Google Scholar 

  121. Ng K, Howells J, Pollard JD, Burke D. Different mechanisms underlying changes in excitability of peripheral nerve sensory and motor axons in multiple sclerosis. Muscle Nerve. 2013;47:53–60.

    PubMed  CAS  Google Scholar 

  122. Misawa S, Kuwabara S, Mori M, Hayakawa S, Sawai S, Hattori T. Peripheral nerve demyelination in multiple sclerosis. Clin Neurophysiol. 2008;119:1829–33.

    PubMed  Google Scholar 

  123. Vogt J, Paul F, Aktas O, Müller-Wielsch K, Dörr J, Dörr S, Bharathi BS, Glumm R, Schmitz C, Steinbusch H, Raine CS, Tsokos M, Nitsch R, Zipp F. Lower motor neuron loss in multiple sclerosis and experimental autoimmune encephalomyelitis. Ann Neurol. 2009;66:310–22.

    PubMed  Google Scholar 

  124. Gartzen K, Katzarava Z, Diener HC, Putzki N. Peripheral nervous system involvement in multiple sclerosis. Eur J Neurol. 2011;18:789–91.

    PubMed  CAS  Google Scholar 

  125. Koff MD, Cohen JA, McIntyre JJ, Carr CF, Sites BD. Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis. Anesthesiology. 2008;108:325–8.

    PubMed  Google Scholar 

  126. Sia S. Nerve blocks, ultrasounds, and multiple sclerosis. Anesthesiology. 2008;109:751–2.

    PubMed  Google Scholar 

  127. Borgeat A, Aguirre J, Neudörfer C, Jutzi H. Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis: what is the likely cause of this complication? Anesthesiology. 2008;109:750–1.

    PubMed  Google Scholar 

  128. Finucane BT, Terblanche OC. Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block. Can J Anaesth. 2005;52:493–7.

    PubMed  Google Scholar 

  129. Ingrosso M, Cirillo V, Papasso A, Merolla V, Cecere F. Femoral and sciatic nerves block (BiBlock) in orthopedic traumatologic lower limbs surgery in patients with multiple sclerosis. Minerva Anestesiol. 2005;71:223–6.

    PubMed  CAS  Google Scholar 

  130. Hebl JR. Ultrasound-guided regional anesthesia and the prevention of neurologic injury: fact or fiction? Anesthesiology. 2008;108:186–8.

    PubMed  Google Scholar 

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Correspondence to Alexandros Makris.

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Makris, A., Piperopoulos, A. & Karmaniolou, I. Multiple sclerosis: basic knowledge and new insights in perioperative management. J Anesth 28, 267–278 (2014). https://doi.org/10.1007/s00540-013-1697-2

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  • DOI: https://doi.org/10.1007/s00540-013-1697-2

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