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Epidural blood patch in a patient with multiple sclerosis: is it safe?
Vesselina Koeva1, Amit Bar-Or, Daniel Gendron
1Department of Anesthesia, McGill University, Montreal, QC, Canada.
Summary
Epidural blood patches (EBP) for postdural puncture headache (PDPH) appear safe in multiple sclerosis (MS) patients, as evoked potential monitoring showed no significant axonal conduction interference. This suggests EBP can be a viable treatment option for PDPH in MS patients.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Multiple sclerosis (MS) involves demyelination and axonal injury, raising concerns about potential interference with axonal conduction during epidural blood patch (EBP) procedures for postdural puncture headache (PDPH).
- The impact of increased epidural pressure from EBP on the vulnerable axons of MS patients is not well understood.
Observation:
- A case study involving a multiple sclerosis patient with PDPH who underwent two EBPs.
- Evoked potential recordings were used to monitor for pressure-induced interference with axonal conduction during the second EBP.
- The patient experienced permanent relief from PDPH symptoms after the second EBP.
Findings:
- The evoked P40 latency responses showed physiologically insignificant changes (39.7 msec pre-EBP vs. 44.3 msec post-EBP).
- This suggests that the epidural blood injection did not cause significant impairment of axonal conduction in this MS patient.
Implications:
- Epidural blood patch may be a safe and effective treatment for PDPH in patients with multiple sclerosis.
- Monitoring somatosensory evoked responses during EBP could be considered in MS patients with known axonal conduction deficits to quantify potential interference.
- Slow injection of blood during EBP may help mitigate pressure increases in the epidural space.
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