title: [Tryptophan immunoadsorption for multiple sclerosis and neuromyelitis optica: therapy option for acute relapses during pregnancy and breastfeeding].
abstract: BACKGROUND
  Approximately 25 % of women with multiple sclerosis (MS) suffer clinically relevant relapses during pregnancy. Almost all disease-modifying drugs are contraindicated in pregnancy. High-dose glucocorticoids have some serious risks, especially within the first trimester. Tryptophan immunoadsorption (IA) provides a safe option to treat MS relapses during pregnancy.
  
  
  OBJECTIVE
  In this case series we describe for the first time the use of tryptophan IA for MS and neuromyelitis optica (NMO) relapses during pregnancy and breastfeeding.
  
  
  METHODS
  In this study a total of 9 patients were retrospectively analyzed of which 7 patients received IA treatment during pregnancy, 2 during breastfeeding and 4-6 tryptophan IA treatments were performed per patient with the single use tryptophan adsorber. Primary outcome was symptom improvement of the relapse.
  
  
  RESULTS
  In this study four patients with MS and one with NMO relapse during pregnancy were treated with IA without preceding glucocorticoid pulse therapy. The MS patients showed improvement in the expanded disability status scale (EDSS) by at least one point, the NMO patient showed significant improvement in visual acuity and two pregnant patients with steroid-refractory relapses showed clinically relevant improvement after IA. Of the patients two suffered from steroid-refractory relapses during breastfeeding and relapse symptoms improved in both cases after treatment with IA. All treatments were well tolerated and no serious adverse events occurred.
  
  
  CONCLUSIONS
  Tryptophan IA was found to be safe, well-tolerated and effective in the treatment of MS and NMO relapses during pregnancy and breastfeeding, sometimes without preceding glucocorticoid pulse therapy. A binding recommendation is limited without prospective clinical studies.
authors.affiliation: Klinik für Neurologie, Krankenhaus Martha-Maria Halle-Dölau GmbH, Röntgenstr. 1, 06120, Halle (Saale), Deutschland, frank.hoffmann@martha-maria.de.
authors.forename: F
authors.initials: F
authors.lastname: Hoffmann
authors.forename: A
authors.initials: A
authors.lastname: Kraft
authors.forename: F
authors.initials: F
authors.lastname: Heigl
authors.forename: E
authors.initials: E
authors.lastname: Mauch
authors.forename: J
authors.initials: J
authors.lastname: Koehler
authors.forename: L
authors.initials: L
authors.lastname: Harms
authors.forename: T
authors.initials: T
authors.lastname: Kümpfel
authors.forename: W
authors.initials: W
authors.lastname: Köhler
authors.forename: R
authors.initials: R
authors.lastname: Klingel
authors.forename: C
authors.initials: C
authors.lastname: Fassbender
authors.forename: S
authors.initials: S
authors.lastname: Schimrigk
mesh_terms: D000208:Acute Disease; D000328:Adult; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D012008:Recurrence; D014364:Tryptophan / Q000276:immunology* / Q000302:isolation & purification*
chemical_list: D014364:Tryptophan