[Glucocorticosteroid therapy in optic neuritis and multiple sclerosis. Evidence from clinical studies and practical recommendations]

High-dose intravenous glucocorticosteroids (GS) are the treatment of choice for acute relapses in patients with multiple sclerosis. We review the evidence from published trials on GS treatment in MS. Several controlled clinical trials have proven the efficacy of high-dose GS in accelerating the recovery from acute attacks. With serial MRI recordings, a reduction in the number of enhancing lesions has been observed after high-dose GS treatment. Definitive long-term effects of GS on disease evolution could not been demonstrated. There is now evidence that ultra-high doses of GS might be superior in comparison to standard pulse treatment regarding relapse rate and disease progression. In experimental autoimmune encephalomyelitis (EAE), an animal model for some features of MS, doses of up to 50 mg/kg methylprednisolone markedly augmented T cell apoptosis in situ, leading to a faster clearance of inflammatory infiltrates. Apoptosis in peripheral blood leukocytes could also be detected after i.v. GS treatment in MS patients. In a recent MRI study, ultra-high doses of GS were significantly more effective in reducing contrast-enhancing lesions and in maintaining blood-brain barrier integrity after a clinical relapse. Further clinical trials are necessary to study the long-term effects of ultra-high doses of GS on disease progression and disability.