# Epidural labor analgesia in a pregnant woman with symptomatic recurrence of myelin oligodendrocyte glycoprotein antibody-associated disease: a case report

## TL;DR

A pregnant woman with a rare neurological condition found relief from symptoms through epidural analgesia during labor, with no worsening of her condition.

## Contribution

This case report demonstrates the safety and potential therapeutic benefit of epidural analgesia in a patient with active MOGAD during labor.

## Key findings

- Epidural analgesia provided effective pain relief and coincided with symptom improvement in a pregnant woman with MOGAD.
- The patient's neurological symptoms resolved postpartum without worsening.
- MRI showed improvement in the patient's brain lesions following delivery.

## Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder that may relapse during pregnancy. The safety of neuraxial anesthesia in such patients remains unclear.

We describe a 32-year-old multiparous woman with MOGAD who developed intractable hiccups due to new medullary lesions at 35 weeks of gestation. Despite steroid pulse therapy, symptoms persisted. At 36 weeks and 2 days, premature rupture of membranes occurred, and hiccups worsened with labor pain. After informed consent, labor epidural analgesia was initiated using low-concentration levobupivacaine with minimal fentanyl. Pain relief coincided with the reduction of hiccups. Vaginal delivery of a male infant was uneventful. Her hiccups resolved by postpartum day 4, and magnetic resonance imaging showed improvement in the lesion. She was discharged on postpartum day 7 without neurological worsening.

Labor epidural analgesia provided effective pain control and was associated with symptom relief in a parturient with active MOGAD.