2024 年 41 巻 3 号 p. 262-265
Multiple sclerosis (MS) occurs in young adults in their 20s to 40s, with a male to female ratio of 1:2. Neuromyelitis optica spectrum disorders (NMOSD) are more common in people in their late 30s to 50s, but are seen from the childhood to the elderly. About 90% of aquaporin 4 (AQP4) antibody–positive patients are female. Women are more likely to develop autoimmune disease and have a higher risk of relapse due to inflammatory demyelination in MS. However, recent advances in disease–modifying drugs have reduced relapses and the rate of conversion to secondary progressive MS is decreasing. Therefore, treatment strategies based on life stages are important to ensure lifelong quality of life despite neurological disease.
In adolescence, vaccination should be completed in anticipation of the future introduction of disease–modifying drugs, attention should be paid to menstrual irregularities associated with steroid treatment, and osteoporosis prevention should be addressed. Appropriate treatment according to disease activity should also be considered in younger patients, as frequent relapses and disability during this period can be a major disadvantage in later life, including employment and marriage.
Pregnancy and childbirth do not have any negative impact on MS, but data show that people with MS are significantly more likely to live alone or be childless. It is therefore important that healthcare providers and patients actively discuss family planning. Appropriate treatment should be given prior to pregnancy, as a stable MS condition prior to conception is important in preventing relapses in the postpartum period. It should be noted that NMOSD, unlike MS, has a negative impact on the course of pregnancy and relapses after delivery. Therefore, the patient's medical and parental support system should be identified before delivery.
On the other hand, men with MS are more likely to develop axonal degeneration and grey matter lesions, and male gender is known to be a poor prognostic factor in MS. The onset of the disease in young adults, leaving physical and cognitive impairments, leads to employment and economic disadvantages. Treatment and social support for male patients is therefore also important.
