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A randomised comparison is made between methylprednisolone, 1 g intravenously daily for 7 days, and a standard ACTH regime for the treatment of multiple sclerosis in acute relapse. It is found that methylprednisolone produces a more rapid clinical improvement than ACTH but confers no longer term benefit when the two treatments are compared at 3 months. It is proposed that intravenous methylprednisolone does have a role to play in the management of a patient with an acute relapse of multiple sclerosis. In the earlier stages of multiple sclerosis morbidity may be reduced by the judicious use of a short course of steroids during an acute relapse. Both intramuscular ACTH' and oral prednisolone2 have been shown to decrease the duration of an exacerbation of multiple sclerosis but no long term benefit follows and more prolonged steroid treatment is usually ineffective.3 Recent reports4-6 have suggested that pulsed therapy with large doses of methylprednisolone may be effective in relapsing multiple sclerosis. This communication presents a randomised comparison of methylprednisolone with a standard ACTH regime. Methods Patients with clinically definite multiple sclerosis according to the criteria of McAlpine' who presented to the Department of Neurology at Middlesbrough General Hospital in acute relapse were considered for inclusion in the trial. Relapse was defined as a symptomatic deterioration within the previous 4 weeks and no patient was improving spontaneously on entry. Each patient gave fully informed consent before randomisation to receive either intravenous methylprednisolone 1 g by slow injection daily for 7 days,

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SUMMARY Serum levels of the complement proteins C3, C4, Cl inhibitor (Cl INH), factor I (C3b inactivator) and factor H (BIH) and plasma levels of cleavage products of C3 (C3c)

In a previous paper' we described the short term results of a study of the effects of 100% oxygen at 2 atmospheres for 20 daily sessions of 90 minutes duration in patients with chronic multiple sclerosis. A total of 120 patients with clinically definite multiple sclerosis were randomised to receive either hyperbaric oxygen or normal air at normal atmospheric pressure within the same compression chamber. The clinical assessment at the end of treatment showed that no patient in either group had improved on the Kurtzke disability status scale.2 The only significant change on the Kurtzke functional systems scale2 was an improvement in 12 of 51 patients in the oxygen group compared with 3 of 47 control patients on the subjective bowel/bladder item. Our short-term findings have now been generally confirmed by a further six doubleblind, placebo-controlled trials involving a total of 264 patients.3-8We now report the results of the clinical assessments made 6 and 12 months after completion of treatment. We also report the results of ancillary investigations conducted before and after treatment: