case_images: PMC11265946_01
case_images: Clinical course of Patient 1. Relationship between duration of disease-modifying drug therapy (IFNbeta   DMF) and relapse during pregnancy and breastfeeding. MRI findings, represented by yellow triangles, illustrate multiple sclerosis at 15 years (A), 24 years (B), and 9 months after delivery (C). Black lightning indicates an asymptomatic new lesion on MRI. The red lightning indicates clinical relapse. IFN, interferon; DMF, dimethyl fumarate, 480 mg/d.
case_images: CRINM2024-7808140.001.jpg
case_images: PMC11265946_01_CRINM2024-7808140.001.jpg
case_images: fig1
case_images: At the age of 15 years, follow-up brain MRI revealed increased asymptomatic plaques with a black hole in the white matter of the right parietal lobe and the white matter around the left lateral ventricle on T1-weighted imaging (Figure 1(A)). IFNbeta-1b was initiated. MS relapse occurred in the left optic nerve at 23 years of age, in the right optic nerve at 24 years of age, and in a subcortical lesion in the left frontal lobe at 25 years of age (Figure 1(B)). IFNbeta-1b was continued, and subsequent brain MRI did not show any evidence of new plaque formation. The child developed normally and had no serious infections (Figure 1(C)).
case_images: PMC11265946_02
case_images: Clinical course of Patient 2. Relationship between duration of disease-modifying drug therapy (IFNbeta   DMF) and relapse during pregnancy and breastfeeding. MRI findings, represented by yellow triangles, illustrate multiple sclerosis at 28 years (A), 9 months after the first delivery (B), and 9 months after the second delivery (C). Black lightning indicates an asymptomatic new lesion on MRI. The red lightning indicates clinical relapse. IFN: interferon, DMF: dimethyl fumarate 240 mg/d.
case_images: CRINM2024-7808140.002.jpg
case_images: PMC11265946_02_CRINM2024-7808140.002.jpg
case_images: fig2
case_images: Brain MRI revealed a new demyelinating lesion in the white matter of the left frontal lobe (Figure 2(A)). MRI performed 9 months postpartum showed a new asymptomatic demyelinating lesion in the left lateral ventricle compared to 4 months before pregnancy (Figure 2(B)). Mixed breastfeeding was continued for 1 year and 3 months postpartum. No relapse was observed at 2 or 9 months postpartum (Figure 2(C)).
case_images: PMC11265946_03
case_images: Clinical course of Patient 3. Relationship between duration of disease-modifying drug therapy (IFNbeta   NTZ) and relapse during pregnancy and breastfeeding. MRI findings, represented by yellow triangles, illustrate multiple sclerosis at 25 (A), 34 (B), and 35 years (C). Orange triangles indicate an intravenous infusion of 300 mg natalizumab. Black lightning indicates an asymptomatic new lesion on MRI. The red lightning indicates clinical relapse. IFN: interferon, NTZ: natalizmub.
case_images: CRINM2024-7808140.003.jpg
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case_images: fig3
case_images: Brain MRI revealed multiple ovoid lesions in the white matter around the lateral ventricle (Figure 3(A)). At 17 months postpartum, thoracic spine MRI showed new asymptomatic lesions at the Th5/6 and Th9/10 thoracic spine levels compared with those at 4 months postpartum (Figure 3(B)). At the age of 35 years, cervical spine MRI revealed a new asymptomatic lesion at C2/3 (Figure 3(C)).
case_images: PMC11265946_04
case_images: Clinical course of Patient 4. Relationship between duration of disease-modifying drug therapy (FTY   DMF   NTZ) and relapse during pregnancy and breastfeeding. MRI findings, represented by yellow triangles, illustrate multiple sclerosis at 26 years (A), 33 years (B), and 1 year and 2 months after delivery (C). Orange triangles indicate an intravenous infusion of 300 mg natalizumab. Black lightning indicates an asymptomatic new lesion on MRI. DMF, dimethyl fumarate; 480 mg/d; FTY, fingolimod 0.5 mg/d; NTZ, natalizmub.
case_images: CRINM2024-7808140.004.jpg
case_images: PMC11265946_04_CRINM2024-7808140.004.jpg
case_images: fig4
case_images: Brain MRI revealed demyelinating lesions in the left pons and middle cerebellar peduncle (Figure 4(A)). Four months after the switch, a follow-up brain MRI showed a demyelinating lesion in the left globus pallidus (Figure 4(B)). NTZ was resumed 14 d postpartum with an EDSS score of 1.0, and feeding with artificial milk was initiated. No new lesions were observed at 1 year or 2 months postpartum (Figure 4(C)).