Relapse Treatment, Part 1

In a previous post, I defined an attack. In this post, I would like to talk about how neurologists treat attacks.

Treating a Relapse

In almost all cases, neurologists will use high doses of intravenous corticosteroids to treat a relapse.  This is one of the oldest, most established treatments in MS.   Corticosteroids are naturally occurring compounds made by the adrenal glands.  There are several different types of steroids that are available, but I usually give methylprednisolone which is also known as Solu-Medrol.  This medication is given for varying lengths of time, ranging for 3-10 days.  Patients do not have to enter the hospital to take this medication if they have access to an infusion center.  In certain exceptional cases, I even try to arrange for this medicine to be given at a patient’s home by a visiting nurse. 

Steroids are usually quite effective in speeding up the rate at which a patient has improvement of her symptoms from a relapse.  In a study of patients with optic neuritis as a first presentation of possible MS, patients treated with intravenous steroids had a lower rate of conversion to clinically definite MS.

Some patients report repeating a significant “boost” from steroids even without a new clinical relapse.  For these patients, steroids are sometimes given on a schedule as infrequently as twice per year.  This protocol is called “pulse steroids.” However, overall, there is no evidence that steroids have any long-term impact in preventing future relapses or on the long-term progression of the disease.

Drawbacks of Steroids

Unfortunately, steroids can have numerous, significant side effects.  For the short courses of steroids given in MS, they are usually well tolerated.  The most common side effects are psychiatric and I have seen some patients become quite manic and out-of-control while on steroids.  Other patients can become quite depressed.  I suggest that all patients take a small dose of a mild sedative called clonazepam while on steroids.  Other side effects for short courses of steroids include temporary weight gain and upset stomach.  For this reason, I also suggest that patients take an antacid while they are on steroids.  Patients with diabetes can have worsening of their blood sugars and may need to be admitted to the hospital for closer monitoring.  The same can be true for patients with hypertension.  Many patients request an oral steroid taper to help minimize the side effects that some feel when they stop receiving intravenous steroids.

Long-Term Side Effects

Over the long-term, steroids can cause even more side effects including cataracts, osteoporosis, bone destruction, cataracts, gastric ulcers, diabetes and significant weight gain.  For this reason, high-dose steroids cannot be given on a continuous basis.  One piece of good news is that steroids are deemed safe in pregnancy, and women who experience relapses during this time can receive steroids if needed.  In my next post, I will discuss treatment options other than steroids for acute exacerbations.