Neurology最新文献

Background and objectives: Peripartum mood and anxiety disorders constitute the most frequent form of maternal morbidity in the general population, but little is known about peripartum mental illness in mothers with multiple sclerosis (MS). We compared the incidence and prevalence of peripartum mental illness among mothers with MS, epilepsy, inflammatory bowel disease (IBD), and diabetes and women without these conditions.

Methods: Using linked population-based administrative health data from ON, Canada, we conducted a cohort study of mothers with MS, epilepsy, IBD, and diabetes and without these diseases (comparators) who had a live birth with index dates, defined as 1 year before conception, between 2002 and 2017. Using validated definitions, we estimated the incidence and prevalence of mental illness (any, depression, anxiety, bipolar disorder, psychosis, substance use, suicide attempt) during the prenatal (PN) period (from conception to birth) and 3 years postpartum. We compared incidence and prevalence estimates between cohorts using simple incidence ratios (IRs) and prevalence ratios with 95% CIs and using Poisson regression models adjusting for confounders.

Results: We included 894,852 mothers (1,745 with MS; 5,954 with epilepsy; 4,924 with IBD; 13,002 with diabetes; 869,227 comparators). At conception, the mean (SD) maternal age was 28.6 (5.7) years. Any incident mental illness affected 8.4% of mothers with MS prenatally and 14.2% during the first postpartum year; depression and anxiety were the most common incident disorders. The first postpartum year was a higher risk period than the PN period (any mental illness IR 1.27; 95% CI 1.08-1.50). After adjustment, mothers with MS had an increased incidence of any mental illness during the PN (IR 1.26; 95% CI 1.11-1.44) and postpartum (IR 1.33; 95% CI 1.20-1.47, first postpartum year) periods than comparator mothers. Similarly, mothers with MS had an increased incidence of all specific mental illnesses except suicide attempt during the PN period vs comparator mothers. Any prevalent mental illness affected 42% of mothers with MS prenatally and 50.3% in the first postpartum year.

Discussion: Mothers with MS had an elevated incidence and prevalence of peripartum mental illness compared with comparator mothers, although residual confounding cannot be excluded. These findings emphasize the need for preventive interventions and early treatment of mental illness.

True seronegativity is extremely rare in Lyme neuroborreliosis (LNB) with reports only in patients with hematological malignancies or under treatment with chemotherapy and B-cell depleting therapies. In these instances, diagnosing LNB can be challenging. We report the case of a 63-year-old patient with 2 independent episodes of LNB. During the first episode with lymphocytic meningitis, anti-borrelial IgG and IgM were detected in serum and CSF. However, initial seropositivity converted to seronegative serum at 8 months of follow-up and remained seronegative during a second episode of LNB while on B-cell depleting treatment for multiple sclerosis. During this second episode, the patient reported painful meningoradiculoneuritis (Bannwarth syndrome), yet no anti-borrelial antibodies could be detected in serum or CSF. Borrelial PCR was positive in CSF, leading to the diagnosis of LNB. Symptoms resolved after antibiotic treatment. Cases of seronegative LNB can occur in the context of B-cell depleting agents. Standard antibiotic treatment is successful for LNB in the context of immunosuppressive treatment. Further diagnostic investigations with PCR or CXCL13 should be considered in cases with high clinical suspicion.