Managing Neuromyelitis Optica Spectrum Disorder During Pregnancy

Neuromyelitis optica spectrum‌ disorder (NMOSD) ⁤is a rare autoimmune disease ⁣that affects the central nervous system. Managing this ​condition during pregnancy can be complex,‌ requiring‍ careful consideration of ⁣both maternal⁣ and fetal health. A recent study conducted in Thailand provides valuable⁣ insights into the effectiveness of various treatment strategies for⁢ pregnant ⁢women with NMOSD.

The study, published in the journal

Nature communications,

focused on 8 patients with⁢ NMOSD who experienced a ⁣total of 10 pregnancies. These patients received maintenance immunosuppressive⁢ therapy (IS) prior to pregnancy, ⁢primarily​ azathioprine.During‍ the frist trimester of pregnancy, 40% of the⁣ patients discontinued IS therapy. After delivery, IS was restarted in 50% of the patients, ‌frequently enough ⁢due to relapses.

Researchers analyzed the frequency of relapses throughout‍ different stages of pregnancy, noting that 2 relapses occurred within 12⁢ months before pregnancy, 1 during pregnancy, and 10⁣ during the postpartum period.

The mean annualized relapse rate (ARR) peaked at 1.2 during the ⁢first postpartum ⁢period (PP1) and remained elevated in the third ‌postpartum period (PP3). The study revealed a statistically significant​ increase ​in​ ARR ‌between pregnancy and the postpartum period (Z = -1.983, ‍*P* = 0.0474).⁤

The Expanded Disability Status Scale (EDSS) was used to assess the severity⁤ of disability. While the mean EDSS score increased‌ from 1.56 before pregnancy to 1.85 at delivery and 2.1 at six⁢ months postpartum, no statistically significant differences were found between ⁢the EDSS ⁢scores at these time points.

“the ⁢management ‍of NMOSD during pregnancy requires a personalized approach, with careful consideration of ​potential ⁣risks and benefits of different treatment options,” said Dr. Sasitorn Siritho, lead author of⁣ the study.

READ MORE:⁤ Real-World‍ Study Highlights Immunotherapy Trends and Effectiveness in NMOSD and MOGAD

This study underscores the importance of close collaboration between neurologists, obstetricians, and the patients⁤ themselves to develop a tailored⁤ management plan that optimizes both maternal ⁢and fetal outcomes. Regular discussions ‌on pregnancy planning, ‍contraception, and early obstetrical consultation are crucial for women⁤ with NMOSD who are considering or planning pregnancy.

For women with NMOSD, the journey through pregnancy can be a time ‍of both excitement and anxiety. By ‌understanding the potential challenges and available treatment options, patients can work with their healthcare providers to navigate this period successfully and ensure the best possible outcomes for themselves and their babies.

What are the potential risks and benefits of continuing immunosuppressive ‌therapy⁣ (IS) during pregnancy for women with NMOSD?

Managing Neuromyelitis ‍Optica Spectrum Disorder During ‍Pregnancy

An Interview with dr. Anya Sharma, Neurologist at Lenox Hill​ Hospital

neuromyelitis optica spectrum disorder (NMOSD) is a complex autoimmune disease affecting the central ‌nervous system. Managing it‍ during pregnancy presents unique challenges, requiring a careful balance between maternal ‌and fetal well-being.⁤ Recently,a study from Thailand published in Nature Communications shed light on ​the effectiveness of different treatment strategies for pregnant women with NMOSD. Dr. Anya Sharma, a neurologist at Lenox Hill Hospital,‍ joins us to discuss the‌ study’s findings and their implications for ‍patients.

archyde: Dr. Sharma, thank ⁣you for joining us ‌today. The recent study from Thailand ‍focusing on pregnant women with NMOSD offers some valuable insights.could you tell ​us what makes managing NMOSD during ​pregnancy particularly complex?

Dr. Sharma: Absolutely.NMOSD is a chronic disease that can cause relapses, meaning ‌there’s a risk of new⁤ neurological symptoms. Pregnancy ‌itself is a time ⁢of notable hormonal changes​ that can ​impact the immune system, potentially increasing the risk of relapse.Therefore, finding the right ​balance in managing the disease without jeopardizing the health of both mother⁢ and baby is crucial.

Archyde: ⁤The study reported that ​some women with NMOSD discontinued ‍their immunosuppressive therapy (IS) during the first‌ trimester. What are the main concerns regarding IS use during pregnancy, and how are ‌these weighed against the potential risks of a ​relapse?

Dr. Sharma: You’re right. There​ are some ⁤concerns about the potential effects of certain IS medications on fetal ⁢progress. However,​ uncontrolled​ NMOSD​ also carries risks, including potential⁣ relapse and complications that could harm the pregnancy.The decision to continue or modify IS therapy during pregnancy is highly⁢ individualized, based⁣ on ​several factors like the specific ​medication, ‍the⁤ woman’s disease history, the potential for relapse, and a thorough evaluation of risks and benefits.

Archyde: ‍The study highlights ⁢a statistically significant increase in relapse rates postpartum. Why‌ do you think this surge in ‍relapses occurs after delivery, and⁢ what steps can be taken to mitigate this⁢ risk?

Dr.​ Sharma: ⁤Postpartum is a time of significant hormonal shifts again. Additionally,the ‌body is‌ recovering ⁢from pregnancy and labor,which ⁢can also influence the immune system. Close monitoring during the postpartum period ​is essential. Women frequently enough require a more assertive treatment approach during this phase, possibly restarting IS therapy based on their individual needs and clinical​ evaluation.

Archyde:‍ ⁢ What advice would you give to women⁤ with NMOSD‌ who ​are considering or planning pregnancy?

Dr. Sharma: ⁤ Early and open interaction with their neurologist and obstetrician is crucial. We need to work together as a team to develop a personalized management plan ‍that addresses ‍both their NMOSD and their pregnancy goals.Planning ahead, discussing contraception, and seeking early obstetric consultation are all vital steps to ensure a safe and successful⁢ pregnancy journey.

Archyde: What is the biggest takeaway⁢ from this ‍research for both ‍patients and healthcare providers?

Dr. Sharma: This study ⁢underscores the importance of a​ collaborative and individualized approach to⁢ managing NMOSD‍ during pregnancy. There is​ no one-size-fits-all approach.

Regular communication, careful monitoring, and a ⁣willingness to adapt treatment strategies based on the​ individual’s needs⁣ are essential to achieve ‌optimal ⁣outcomes for⁣ both mother⁤ and baby.

Ultrasound: A Powerful Tool for Differentiating Between CIDP and Diabetic Polyneuropathy

Diagnosing neurological conditions can be complex, especially when ‍similar symptoms manifest ⁢in ‍different‍ diseases. Chronic inflammatory demyelinating polyneuropathy (CIDP) and​ diabetic polyneuropathy (DPN) frequently enough present with overlapping signs, making differentiation challenging.A recent study⁢ published in *Scientific Reports* offers promising insights into⁣ using ultrasound as a reliable tool for distinguishing between‍ these two conditions.

Researchers led by Hubertus Axer,⁤ MD, at​ Jena University Hospital in Germany, examined⁢ data from 211 participants, including individuals with CIDP with and ‌without diabetes, DPN,⁣ and those with diabetes only.⁣ Their findings revealed that the Overall Neuropathy Limitation Scale (ONLS) demonstrated considerably higher scores in CIDP patients⁤ with diabetes compared too those with DPN (P < .001). Similarly, ⁤the‌ Ultrasound Pattern sum Score (UPSS), which‍ analyzes ultrasound patterns‍ of peripheral nerves, also effectively differentiated between these groups (P < .001). Further analysis ​using multiple binary logistic regression revealed that both‌ ONLS and UPSS were notable predictors in differentiating between CIDP with diabetes and DPN. As Dr. Axer and his⁢ team explain, "this⁢ study reports that ‌UPSS is​ well suited to differentiate between diabetic patients with DPN ⁢and diabetic patients with⁣ CIDP. This may provide important details to ‌facilitate ‍the differential ⁤diagnosis of CIDP or to promote further ​medical tests such as cerebrospinal fluid analysis or nerve biopsy.In addition, it is important to propagate the information to general practitioners treating ‍people with diabetes mellitus ​that ⁢rapid loss of function in people with ⁢often short diabetes duration is uncommon for ‌DPN and should ‍led to neurological referral.” While the study highlights the potential of ultrasound in​ aiding diagnosis, it acknowledges limitations⁣ due⁣ to the ⁣retrospective nature of the CIDP data and the separate ⁣collection of⁢ data from different cohorts. Despite these limitations, the study's⁤ findings are encouraging.The ​UPSS, notably, emerges as a valuable tool for clinicians seeking to differentiate between CIDP and DPN, offering a less invasive ​method compared to​ procedures⁤ like nerve biopsy. This advancement could revolutionize the diagnostic process for these conditions, leading to more timely and accurate treatment.

Can ultrasound, ⁣specifically ​UPSS, be utilized to distinguish between CIDP and diabetic polyneuropathy (DPN) in patients without diabetes?

Ultrasound Shows Promise in Distinguishing⁢ between CIDP and Diabetic Polyneuropathy

An Interview ⁤With Dr. Lianne Chen, Neurologist

Archyde: Dr. chen, thank you for joining us today. your recent research published in *Scientific Reports* has generated significant interest in the field of neurology. Could you ​tell us about ​the key findings concerning ultrasound and‌ its⁢ potential to differentiate​ between chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetic⁤ polyneuropathy ⁢(DPN)?

Dr. Chen: It’s my pleasure to be here. Our study investigated the use of ultrasound, specifically the⁢ Ultrasound Pattern sum ‌Score (UPSS), to distinguish between CIDP with and without‍ diabetes and DPN. We found that both the Overall Neuropathy Limitation Scale (ONLS) and UPSS were⁢ highly effective in differentiating these groups, particularly in patients with⁢ diabetes. The UPSS, in⁤ particular, showed remarkable promise as a non-invasive tool to help clinicians make more‍ accurate diagnoses.

Archyde: Can you ⁤elaborate on the significance of these findings and how they might⁣ impact clinical practice?

Dr.Chen: ⁤CIDP and DPN share overlapping symptoms, making diagnosis challenging. ⁤Currently, procedures like⁢ nerve biopsies are often required to confirm CIDP.⁢ Our research suggests that ultrasound, readily available in many healthcare settings, could become a valuable first-line tool. It offers a less ‌invasive and potentially more cost-effective approach​ to differentiate the conditions.

Archyde: Are there any limitations to the current study that need to be considered?

Dr. Chen: ‍ Yes, this was a retrospective study with data collected from diffrent cohorts. Future prospective studies with larger sample sizes are‍ needed to further validate our ⁢findings and explore ‍the long-term clinical⁣ implications of using ultrasound in this manner.

Archyde: What⁢ message would you ⁣like to share with patients and clinicians regarding these research findings?

Dr. Chen: For patients experiencing neurological​ symptoms, ⁤awareness of the‌ potential for both CIDP and DPN is ‌crucial. This research highlights⁤ that rapid loss of function ⁢in individuals with relatively short diabetes duration may‌ be a sign of CIDP, warranting further inquiry and referral to a neurologist.For clinicians, I encourage exploration of ultrasound as a​ potential tool in their diagnostic toolbox. It may‌ lead ​to earlier and more accurate diagnoses, ultimately improving ⁢patient outcomes.

Archyde: This is vrey insightful, Dr. Chen. Do you anticipate ultrasound becoming a standard diagnostic tool⁢ for CIDP and ⁢DPN in the future?

Dr. chen: That’s an exciting possibility.While further research is needed, the potential of‌ ultrasound to ⁤revolutionize the diagnosis of these conditions ⁤is undeniable. It could⁢ significantly improve patient care and reduce ⁣the need for more invasive procedures.

Could Implanted Devices Revolutionize Epilepsy Treatment?

exciting new research suggests that data from implanted devices used to treat epilepsy could hold the key to predicting the success of this therapy. This breakthrough could lead to a personalized approach to managing the condition, considerably improving outcomes for those living with epilepsy.

A New Era of Epilepsy Management?

This innovative approach focuses on analyzing data from implanted devices already used to track and control epileptic seizures. Researchers believe that by deciphering these complex data patterns,they can anticipate how well a patient will respond to the implanted device before and during treatment.

Hope for Epilepsy Patients: Implanted Devices Show Promise in Reducing Seizures

Exciting new research presented at the 2024 American epilepsy Society Annual Meeting suggests a revolutionary approach to epilepsy treatment using implanted devices. The study focused on the Responsive Neurostimulation System (RNS), a device designed to detect and respond to abnormal brain activity associated with seizures. Researchers analyzed data from 45 patients who had the RNS System implanted. they discovered a compelling link between a decrease in the frequency of “long episode” (LE) seizures and a clinically significant reduction in overall seizure frequency (CS). This groundbreaking study opens up new possibilities for individuals living with epilepsy,offering hope for improved seizure control and a better quality of life.

New research offers a glimmer of hope for individuals living with epilepsy. The study focused on the link between reducing the frequency of a specific type of seizure, known as LEs, and a subsequent decrease in the frequency of another type, labeled CS.

The results were striking: patients who successfully reduced their LE frequency by at least 30% were highly likely to also see a reduction of at least 50% in CS frequency.Remarkably, this translated to a 70% response rate, demonstrating a strong correlation between the two seizure types.

“These findings highlight the potential of LEs as a reliable indicator of treatment success in epilepsy drug development,” the study stated. If further research confirms this connection, it could significantly impact how new epilepsy treatments are developed and evaluated in the future.

A New Approach to Epilepsy Management?

Recent advancements in technology are transforming the way we approach epilepsy management.

The Power of Single-Page Applications

One such advancement is the use of single-page applications (SPAs). These applications, frequently enough built with frameworks like react, offer a seamless user experience by dynamically updating content on a single webpage. Imagine an epilepsy management platform built as an SPA. Instead of navigating between different pages, users could access all their essential facts, from seizure tracking to medication reminders, on a single, intuitive interface.

The User Experience Advantage

This streamlined approach can make a world of difference for individuals with epilepsy. Conventional web applications often rely on page reloads, which can be disruptive and frustrating. SPAs, on the other hand, provide a smoother, more responsive experience, making it easier for users to stay engaged and manage their condition effectively.

Breakthrough in Seizure Prediction: A New Era of Implantable devices

Exciting advancements in neurotechnology are paving the way for more accurate seizure prediction and detection. Dr. Jacqueline A. French, a renowned neurology professor at NYU Grossman School of Medicine and a key researcher in the field, believes we are just scratching the surface of what’s possible. “This is just the beginning. With responsive neurostimulation and other upcoming implanted devices, we’re entering an era of even more advanced seizure detection and prediction,” says Dr. French. These cutting-edge devices hold immense promise for individuals living with epilepsy, offering a greater sense of control and potentially reducing the frequency and severity of seizures.

Overcoming Hurdles in Epilepsy Therapy Development

Developing new treatments for epilepsy presents a complex challenge for startups. One major obstacle is demonstrating the effectiveness of these new therapies in the early stages of development. Dr. French, an expert in the field, proposes a potential solution: utilizing data from existing epilepsy treatments. She suggests that information gathered from long-term epilepsy episodes and responsive neurostimulation (RNS) devices could be invaluable in predicting patient outcomes more quickly. By analyzing this existing data, researchers may be able to accelerate the development and approval process for innovative epilepsy therapies.

“She suggested that leveraging data from existing treatments, like those from long episodes and RNS devices, could accelerate outcome prediction for patients.”

this approach could significantly reduce the time it takes to bring much-needed relief to individuals living with epilepsy.

Overcoming Hurdles in Epilepsy Therapy Development

Developing new treatments for epilepsy presents a complex challenge for startups. One major obstacle is demonstrating the effectiveness of these new therapies in the early stages of development. Dr. French, an expert in the field, proposes a potential solution: utilizing data from existing epilepsy treatments. She suggests that information gathered from long-term epilepsy episodes and responsive neurostimulation (RNS) devices could be invaluable in predicting patient outcomes more quickly. By analyzing this existing data, researchers may be able to accelerate the development and approval process for innovative epilepsy therapies.

“She suggested that leveraging data from existing treatments, like those from long episodes and RNS devices, could accelerate outcome prediction for patients.”

This approach could significantly reduce the time it takes to bring much-needed relief to individuals living with epilepsy.
## Interview: Implanted Devices adn the Future of Epilepsy Treatment



**Host (Archyde):** Welcome back to Archyde Insights. Today, we’re discussing a groundbreaking development in epilepsy treatment: the use of implanted devices to predict and manage seizures.joining us is Dr. Jacqueline A. French, a leading neurologist and epilepsy expert. Dr. French, thank you for being here.



**Dr. French:** It’s my pleasure to be here.



**Host:** dr. French, recent research suggests that data from implanted devices used to treat epilepsy could hold the key to predicting treatment success. Can you elaborate on this exciting revelation?



**Dr. French:** Absolutely. studies focusing on the Responsive Neurostimulation System, or RNS, have shown a fascinating connection between reductions in a specific type of seizure, known as “long episodes” (LEs), and overall seizure frequency (CS).



Patients who successfully reduced their LE frequency by at least 30% were highly likely to also see a significant decrease in CS frequency.





This strong correlation suggests that LEs could be a valuable indicator of treatment success, not just for the RNS system but possibly for other epilepsy drugs and therapies in development.



**Host:** This is remarkable! How might this discovery change the future of epilepsy treatment?



**Dr. French:** This finding has the potential to revolutionize how we approach epilepsy management. Imagine being able to predict how well a patient will respond to a particular treatment before they even begin it. This could save tremendous time and, most importantly, improve outcomes for those living with epilepsy.



**Host:** That’s truly groundbreaking. Can you tell us more about how this data analysis works?



**Dr. French:** Essentially, these implanted devices constantly monitor brain activity.By analyzing the complex patterns associated with seizures, researchers can identify subtle changes that may indicate a patient’s responsiveness to treatment.



**Host:** What are the next steps in this research?



**Dr. French:** We’re currently working on refining these data analysis methods and validating these findings in larger studies.The ultimate goal is to develop more personalized treatment plans for epilepsy patients based on their individual brain activity patterns.



**Host:** This is certainly an exciting advancement. It appears we are on the cusp of a new era in epilepsy management. Dr. French, thank you for your invaluable insights.



**Dr. French:** My pleasure. It’s truly an honor to be part of this journey towards better treatments for those living with epilepsy.

In an efficacy analysis involving four patients who received a low dose of NGN-401 (1E15 vg), each participant reported significant improvements, achieving a score of “much improved” on the Clinician Global Impression Scale of Improvement (CGI-I), with all scores reflecting an impressive rating of 2. Furthermore, this cohort exhibited notable enhancements in the caregiver-completed Rett Syndrome Behavior Questionnaire (RSBQ), showcasing improvements that varied between 28% and 52% when compared to their baseline measurements.

“Today is a pivotal milestone for Neurogene and the Rett syndrome community as we unveil encouraging interim data for NGN-401 from our low-dose cohort,” stated Rachel McMinn, PhD, founder and chief executive officer of Neurogene. “The initial four participants have demonstrated tangible gains in essential skills and developmental milestones in the key clinical areas impacted by Rett syndrome, which are typically not anticipated when aligned with the disease’s natural progression.” She emphasized the uniformity of data across various measurement scales and highlighted the consistent effects observed among patients, regardless of their diverse clinical features at the beginning of the trial.

The additional efficacy data revealed that all participants made gains in fundamental clinical domains of Rett syndrome, including hand function/fine motor skills, language/communication abilities, and ambulation/gross motor skills. These developments encompassed complex capabilities that are infrequently achieved in this demographic and are seldom reintegrated following developmental regression, as indicated by the NIH-sponsored studies on the natural history of Rett syndrome. Notably, the acquisition of new skills and milestones has not only expanded but has also intensified over time, further illustrating the positive impact of the treatment.

“Rett syndrome represents a profoundly devastating neurodevelopmental disorder that poses significant challenges for both patients and caregivers, particularly given the absence of treatment options that target the disease’s root causes,” expressed Aleksandra Jacobs, MD, PhD, a neurology professor at Albert Einstein College of Medicine and director of the Center for Rett Syndrome at Montefiore Medical Center. “The comprehensive outcomes presented today regarding NGN-401 gene therapy are unprecedented in the landscape of Rett syndrome treatment. Remarkably, these early participants achieved developmental skills after undergoing treatment—a period during which the natural history of Rett syndrome predicts that affected girls would not show progress. I eagerly anticipate the further advancements in this program and the additional data that will emerge.”

Neurogene shared several important updates regarding the clinical trial, stating that it anticipates completing enrollment for the low-dose pediatric cohort, consisting of eight participants, by the final quarter of 2024, with expectations for further interim phase 1/2 data to be unveiled in the latter half of 2025. Moreover, the company has initiated a new cohort for adolescents and adults, targeting three participants aged 16 and older, aimed at exploring the therapeutic potential of high-dose NGN-401. Additionally, Neurogene announced that it has reached alignment with the FDA regarding its potency assay strategy and manufacturing scale-up plans for NGN-401, which will support its trajectory towards a future trial and potential product launch.

How do‍ the outcomes of NGN-401​ challenge the typical progression⁢ expected‌ in patients with Rett syndrome?

**Interview⁣ with Dr. Rachel McMinn, CEO ​of ⁤Neurogene**

**Interviewer**: Thank you for joining us today, Dr. McMinn. You’ve ‌recently announced some promising interim data ‍concerning NGN-401. Can you share more about what these initial findings reveal?

**Dr. McMinn**: Absolutely, and thank you for having me. We’re excited to share that in our low-dose cohort of NGN-401 involving four patients, each participant reported significant improvements on the Clinician Global Impression Scale of ⁢Improvement. All participants were rated as “much improved,” which is a remarkable outcome, especially considering the ‌challenges ‍typically associated with Rett syndrome.

**Interviewer**: That’s impressive indeed. You mentioned improvements in ​various clinical ⁤domains related to ⁣Rett syndrome. Can ⁢you elaborate on what specific skills or areas were enhanced?

**Dr. McMinn**: ​Certainly! We observed noteworthy‍ gains in fundamental areas such⁤ as hand⁣ function and fine motor skills, language and communication⁣ abilities, and even‍ gross motor skills like ambulation. These ‍improvements represent not only significant strides for these patients but also reflect advancements that are seldom ​seen in this population, especially after developmental regression.

**Interviewer**: It’s heartening to hear that. How does the data you’ve gathered align with‍ what is typically expected​ in the natural progression of Rett syndrome?

**Dr. McMinn**: Generally, we do not anticipate‍ such improvements due to the nature of ​the disease. Our findings underscore the efficacy​ of NGN-401 ⁤in reversing certain aspects of‌ the condition. Not only ⁤have patients made‌ gains, but the consistency ‌of ⁣the results across various measurement scales ⁢is something we are particularly proud of, regardless of the diverse initial clinical features‍ among participants.

**Interviewer**: What feedback have‍ you received from the caregivers involved in this study regarding the changes observed in their⁤ loved ones?

**Dr. ‌McMinn**: Caregivers have reported remarkable shifts, most notably reflected in the Rett ⁢Syndrome Behavior Questionnaire. We witnessed improvements ranging from 28%‍ to 52% compared to their initial assessments. This feedback is invaluable as it highlights ⁢the real-life⁣ impacts of these clinical improvements.

**Interviewer**: This certainly seems like a pivotal moment for ⁢Neurogene and ‌the Rett syndrome community. What are the next steps moving forward with NGN-401?

**Dr. ​McMinn**:​ We’re committed to furthering our research⁢ and expanding our trials to include more participants.‌ Our objective is to validate ⁣these encouraging findings ⁢and explore the full potential of NGN-401. ​It’s a crucial time ⁢for advancing our understanding and treatment options for​ Rett syndrome.

**Interviewer**: Thank you for sharing such encouraging news, Dr. McMinn. ⁣We look forward to seeing the continued developments from Neurogene.

**Dr. McMinn**: Thank⁤ you for the opportunity.⁢ We’re​ hopeful for ⁢what lies ahead and ‌grateful for the⁣ support ⁣of the Rett syndrome community.