Megadose corticosteroids in multiple sclerosis

Intramedullary cervical tuberculoma

“…Megadose corticosteroid therapy restores the blood brain barrier, reduces oedema and prevents circulatory toxins or immunoactive cells form entering the CNS. 4 Cranial MRI of our patient showed multiple granuloma but the paraplegia was probably due to a spinal granuloma because of the horizontal levels of sensory loss. Cervical spinal cord pathology usually results in quadriplegia; partial or small lesions, however, may manifest with paraplegia and a dropped sensory level due to laminar arrangement of motor and sensory ®bres.…”

Multiple Sclerosis: A Family Practice Perspective

“…Mild attacks that do not cause functional decline may not require treatment, but if ability is affected, the current treatment is corticosteroids. Short bursts of intravenous (IV) methylprednisolone of 500 mg to 1000 mg daily for 3 to 7 days with or without a prednisone taper are commonly used [12,13]. Oral prednisone of 500 mg per day for 5 days with a 10 day tapering period has also shown a benefit compared to placebo [12][13][14] without a statistical difference between IV and oral form [12,15].…”

“…Short bursts of intravenous (IV) methylprednisolone of 500 mg to 1000 mg daily for 3 to 7 days with or without a prednisone taper are commonly used [12,13]. Oral prednisone of 500 mg per day for 5 days with a 10 day tapering period has also shown a benefit compared to placebo [12][13][14] without a statistical difference between IV and oral form [12,15]. However, oral methylprednisolone should not be offered to patients with acute optic neuritis, since patients on oral prednisone are more likely to suffer reoccurrences of optic neuritis compared to patients on IV methylprednisolone, who have a quicker recovery of visual loss [16][17][18].…”

Risk of cataract and glaucoma in patients with multiple sclerosis

“…15 In addition, it has been hypothesized that glaucoma neuropathy may be related to optic neuropathy, which can have various aetiologies including MS. 16 Not only MS itself, but also the use of high dosage systemic GCs may increase the risk of cataract. 17,18 Treatment with short courses of intravenous methylprednisolone (500-1000 mg daily for 3-5 days), with or without a short prednisone taper, are commonly used in the treatment of relapses in patients with relapsing-remitting MS. 19,20 Previous studies have shown that (long-term) use of GCs increases the risk of cataract. 17,18 The interaction of the GC with the proteins of the lens results in an accumulation of granular material and vacuoles at the posterior pole of the intraocular lens.…”