Multiple Sclerosis: Corticosteroid Treatment for Acute Relapses

Given that most relapses gradually get better on their own, you’re probably wondering how your doctor decides whether to treat a relapse or not. Here’s the bottom line answer: In general, neurologists will treat the relapse with corticosteroids if it’s interfering significantly with your daily life.

For example, if your vision or ability to walk are impaired — and you can’t drive your car, function at work, or take care of your kids — your doctor is likely to recommend treatment. If, however, your symptoms are less invasive — maybe you’re experiencing increased fatigue, some numbness or tingling on your left side, or spasticity (increased stiffness) — the recommendation may be to treat whatever symptoms you’re having and let the relapse resolve on its own.

The main reason that doctors don’t treat every relapse that comes along is that the corticosteroids that are used are more of a quick fix than a long-term solution — and they can pose problems of their own.

What are corticosteroids?

Corticosteroids are hormones that are produced in the human body by the adrenal glands (these are very different from the anabolic steroids used by athletes, so don’t get your hopes up for next year’s World Series). When prescribed as a medication, these hormones have a number of physiologic effects on different organ systems, but they’re most widely used for their anti-inflammatory actions.

For example, in MS, corticosteroid medications help reduce the inflammation that occurs during a relapse so that the relapse comes to an end more quickly. A study is currently under way to determine if these meds also have some long-term benefit on the progression of the disease, but earlier studies haven’t demonstrated any long-term benefit.

Some corticosteroid medications, such as prednisone, are generally given orally. Others, such as Solu-Medrol (methylprednisolone) and Decadron (dexamethasone) are given by intravenous infusion. Most MS specialists recommend a three- to five-day course of high-dose intravenous (IV) steroids as the treatment of choice for severe MS attacks because this regimen seems to provide maximum benefit with the fewest side effects.

These days, doctors most often give this treatment on an outpatient basis. Your doctor may also prescribe what’s called a steroid taper — a gradually decreasing dose of oral steroids over a one- to two-week period — to prolong the benefit of the medication while easing you off it more slowly.

As an alternative to IV steroids, a short course of high-dose oral steroids may also be appropriate. Your neurologist will work with you to figure out the best option for your particular circumstances.

What to expect from MS corticosteroids treatments

The physician’s goal in prescribing corticosteroids is to help you get back on track more quickly — especially if your relapse is interfering with your daily activities. In other words, the corticosteroids jump-start your recovery from the attack. But they don’t impact the course of your MS over the long haul.

While most people do well with these medications, it’s difficult to predict exactly what your response will be. You may, for example, feel dramatically better within a couple of days — so good and energized, in fact, that you wish you could stay on corticosteroids forever (one woman commented that her closets are always at their cleanest when she’s on corticosteroids).

Or you may experience little relief from your symptoms, in which case you and your doctor will focus on managing your symptoms and wait for the relapse to resolve itself. Or if the relapse is particularly severe, your neurologist may recommend another treatment strategy.

You may find corticosteroids easy to tolerate, and you may enjoy the energy boost, or you may find yourself struggling with some pretty intense irritability or mood swings ranging from “high” and energized during the treatment to down and depressed as you come off the medication.

Be aware of the range of possible corticosteroid reactions because they can all happen to anyone at one time or another. In other words, responding positively to corticosteroids during one relapse doesn’t necessarily mean that you’ll respond positively the next time, and having one negative experience doesn’t mean they’ll all be negative.

Side effects of MS corticosteroid treatment

Although most people tolerate treatment well, corticosteroids can produce a variety of side effects — both immediate and long term — and it’s because of these side effects that doctors recommend the short three- to five-day course.

The immediate side effects can include stomach irritation, elevation of blood sugar, water retention/weight gain, restlessness, difficulty sleeping (which is why the closets get cleaned), and mood swings. Chances are that you won’t run into any problems, but your doctor can prescribe medication to help you sleep or to minimize stomach irritation if necessary.

Corticosteroids should not be used on a continuous basis because they can cause serious and debilitating problems such as stomach ulcers, hypertension, cataracts, and osteoporosis (thinning of the bones).

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