Natalizumab PML Risk – JCV 2.8 — SCE Neurology MCQ

Correct answer: C — Pre-conception planning for MS treatment and rebound risk

The best answer is “Pre-conception planning for MS treatment and rebound risk”. Pregnancy planning in MS is treatment-specific: clinicians balance recent disease activity, drug washout, fetal exposure and rebound, and create a postpartum plan rather than applying a universal stop-or-continue rule. “Stop every disease-modifying treatment immediately without neurology review” is less appropriate because abrupt cessation can expose the patient to preventable rebound with some high-efficacy drugs “Continue any treatment after considering its pregnancy licence or fetal risk” is less appropriate because some agents are contraindicated or require timed exposure decisions “Use repeated corticosteroid pulses throughout pregnancy as routine prevention” is less appropriate because maintenance steroid pulses add maternal and fetal harms and are not routine DMT replacement “Avoid folic acid because it interferes with MS treatment” is less appropriate because pre-conception nutritional care remains appropriate and does not undermine MS management

Reference: NICE NG220: Multiple sclerosis in adults — recommendations. https://www.nice.org.uk/guidance/ng220/chapter/Recommendations