Six consecutive patients with multiple sclerosis and lesions contrast enhancing on computed tomographic scan were treated with high-dose intravenous infusions of methylprednisolone. Double-dose delayed computed tomographic scans were repeated at varying intervals during corticosteroid treatment. Contrast enhancement of sclerotic plaques was reduced or eliminated within as little as 8 hours after the first infusion. Rapid associated partial clinical improvement was noted in four patients with recent exacerbations of disease activity. Similar attenuation of contrast-enhancing plaques and clinical improvement were less predictable following oral corticosteroid therapy in conventional dosage. These studies suggest that the dose, route of administration, and duration of corticosteroid therapy in multiple sclerosis may partially determine the effect of treatment.

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We have found a significant relationship between blood lymphocyte count and prognosis in 45 patients receiving either total lymphoid irradiation or sham irradiation for chronic progressive multiple sclerosis. Patients with sustained lymphocyte counts less than 900 mm-3 for prolonged periods after treatment showed less rapid progression over the ensuing 3 years than did patients with multiple sclerosis who had lymphocyte counts above this level (p less than 0.01). Our results suggest that a simple laboratory test, the absolute blood lymphocyte count, may serve as a valuable barometer for monitoring the amount of immunosuppressive therapy needed to prevent progression in patients with multiple sclerosis, and possibly other autoimmune diseases.

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