How to manage multiple sclerosis in a female?

Question

Hello doctor,

My 31-year-old daughter was diagnosed with multiple sclerosis 18 months ago after she experienced numbness and weakness in her left arm during her last pregnancy. The neurologist confirmed the diagnosis with MRI findings showing multiple lesions in the brain and spinal cord, along with the presence of oligoclonal bands in the cerebrospinal fluid.

She has been on interferon beta-1a injections since then, but she continues to have relapses every three to four months. Her EDSS score has increased from 2.0 to 3.5 over the past year, which the doctor has explained indicates disease progression. Her fatigue is severe and has become so disabling that she can barely manage daily activities or take care of her two-year-old daughter and four-year-old son.

She wishes to have another baby, but the neurologist has advised that multiple sclerosis may worsen during pregnancy and breastfeeding. Some of the newer multiple sclerosis medications, such as Fingolimod or Natalizumab, may be more effective, but they are not considered safe if she plans to become pregnant.

Although her husband is very supportive, I can see the emotional and physical strain this situation is placing on their marriage. She has also developed depression, which has made coping even more difficult for her and the family.

I am concerned that her current treatment is not adequately controlling the disease, and I worry about her mobility worsening if this continues. Should she consider switching to a different multiple sclerosis treatment, even if it means delaying plans for another pregnancy for several years? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

I understand your concern, and you are right to be worried. Frequent relapses and a rising Expanded disability status scale or EDSS, a scoring system used to measure disability in multiple sclerosis (attachment removed to protect the identity of the patient). Despite treatment with interferon, her condition indicates that her current therapy is not adequately controlling her multiple sclerosis (a chronic autoimmune disease in which the immune system attacks the brain and spinal cord).

In young women like your daughter, ongoing disease activity can lead to permanent neurological disability, so effective disease control is extremely important. Pregnancy itself usually does not worsen multiple sclerosis and may even reduce relapse rates due to hormonal and immune changes. However, the period after delivery carries a higher risk of relapses, which is why careful planning is essential.

She does not necessarily have to choose between effective treatment and motherhood. There are pregnancy-compatible treatment options, such as Glatiramer acetate (an immune-modulating medication considered safe during pregnancy), and in selected cases, carefully timed Natalizumab (a monoclonal antibody that reduces immune cell entry into the brain) or anti-CD20 therapy (medications that target specific immune cells) given before conception. These approaches can provide better disease control while still allowing the possibility of pregnancy at a later stage.

Waiting for several years while the disease remains active is generally not advisable, as neurological disability can accumulate over time and may not be reversible. Her severe fatigue and depression (a common mood disorder frequently associated with multiple sclerosis) also require active treatment, as both are common in this condition and significantly affect quality of life, family functioning, and emotional well-being.

The best approach is a planned switch to a more effective treatment with a clearly defined pregnancy strategy. This should be coordinated closely between neurology and obstetrics specialists, so that her multiple sclerosis is stabilized first and any future pregnancy is safer for both the mother and the baby.

I hope this helps you.

Kindly revert if there are any queries.

Thank you.