Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system which, at the beginning, typically arises with relapsing episodes of neurological deficiencies. Subsequently, symptoms may persist, and in approximately 65% of the patients, a conversion into a secondary progressive (SP) course with a continuous deterioration of disability occurs. Patients (15-20% of the patients suffer from a primary progressive (PP) MS with a steady worsening of symptoms from onset [1]).Until now, pathomechanisms of MS are not sufficiently understood. Inflammatory demyelinating as well as neuroaxonal degenerative processes are involved in pathogenesis and result in cerebral and spinal tissue damage [1].Treatment of acute exacerbation includes usually the application of intravenous methylprednisolone for 3 to 5？days [2,3]. To reduce frequency and severity of relapses as well as the progression of disease in general, an immunomodulatory therapy with interferon beta (IFN-β) or glatiramer acetate (GA) is necessary [4,5]. In patients with high disease activity or insufficient effect of IFN-β or GA, the monoclonal antibody natalizumab or the sphingosine receptor modulator, fingolimod, is available [6,7]. Another agent, which is approved for second-line-therapy, is mitoxantrone [8]. Of particular importance to reduce relapses and disease progression is an early initiation as well as a long-lasting and continuous administration of these therapies [9,10].In Europe, MS prevalence rates range between 10 and 187 per 100,000 with a higher rate in northern countries [11]. In Germany, approximately 120,000 people suffer from MS [12]. Patients typically experience first symptoms between the 3rd and 5th decade of life, and thus, MS mainly affects patients in childbearing age. It shows a female predominance of 2 to 3:1 [11-13]. Consequently, a high need for counseling exists on topics as family planning, pregnancy and child birth. Seeing that even healthy couples have many concern