Corticosteroids in the management of acute multiple sclerosis exacerbations

Abstract

Multiple sclerosis (MS) is an autoimmune, inflammatory demyelinating disease of the central nervous system characterized in the majority of the patients by a relapsing-remitting disease course. For decades high-dosage corticosteroids (CS) are considered the cornerstone in the management of acute MS relapses. However, many unanswered questions remain when it comes to the exact modalities of CS administration. In this review on behalf of the Belgian Study Group for MS we define the efficacy of CS in reducing MS-related morbidity and examine whether the effect is different according to type of CS, route of administration, cumulative dosage, timing of initiation and disease course. We also review the use of CS in combination with other MS treatments and during pregnancy and lactation. Furthermore, we delineate the relevant adverse events due to a pulse CS regimen and present a decision tree that can be used when treating MS relapses in clinical practice.

The association between multiple sclerosis and pain medications

“…For treatment naïve MS patients, there are four first line treatments recommended in Sweden: glatiramer acetate (GA), interferon (IFN)-β 1a, and, IFN-β 1b, and dimethyl fumarate (DMF). Corticosteroids are often also used in instances of acute MS relapse 59 .…”

Available Pharmacological Options and Symptomatic Treatments of Multiple Sclerosis

“…Corticosteroids are observed to reduce inflammation, limit the symptoms and increase recovery rate. 53 On the other hand, corticosteroids neither improve the outcomes of a relapse nor participate in preventing any possible disability that occur during a relapse. 54 Clinical investigations have recommended the use of methylprednisolone in the management of MS relapse.…”

Tryptophan immunoadsorption during pregnancy and breastfeeding in patients with acute relapse of multiple sclerosis and neuromyelitis optica

“… 9 – 13 In addition, potential risks for the mother, like hypertension, neuropsychiatric symptoms and a diabetes-inducing effect, have to be considered, which are not limited to early pregnancy. 14 , 15 After the first trimester, intravenous steroids may be used relatively safely during pregnancy. 16 In postpartum relapses treated with methylprednisolone, the amount in breast milk can be limited with a 2–4-h delay of breastfeeding after intravenous methylprednisolone infusion.…”