October 2nd, 2002
Medscape Neurology & Neurosurgery
A 26 year-old woman with relapsing-remitting MS since the age of 17 has numerous lesions on brain MRI, none active. She has no disability. She is now pregnant and planning for labor and delivery. Is it safe for her to receive epidural anesthesia? Is spinal anesthesia contraindicated in general for patients with MS?
Marilee Shebuski, MD
from Mark S. Freedman, MD, 10/02/2002
This question raises a number of points, most of them the subject of myths over the years: First, the dreaded "spinal tap," and then the infusion of epidural/intraspinal anesthesia. Let's deal quickly with the first issue -- there is really no effect of a lumbar puncture or epidural anesthesia on MS. Regarding the mode of anesthesia, any data relating a concern about spinal/epidural anesthesia are purely anecdotal. These concerns probably are linked to the fact that there is a small but, in some cases, definite risk of rebound relapses postpartum that is unrelated to type of delivery or mode of anesthesia.
A quick review of the literature pulls up a few case reports describing rare cases of postpartum relapse in women with MS who received epidural anesthesia. One raised some concern over the use of high concentrations of bupivacaine (> 0.25%), and another discusses the possibility of triggering a bout of autonomic dysreflexia in a patient obviously quite impaired with preexisting spinal disease.
The bottom line is that epidural or spinal anesthesia appears safe and is not contraindicated in general for patients with MS.
Mark Freedman, MD, Professor of Neurology, University of Ottawa, Canada, and Director, Multiple Sclerosis Clinic, Ottawa Hospital, Canada.
Medscape Neurology & Neurosurgery 4(2), 2002.
© 2002 Medscape