Related Experiment Videos
[Therapeutic indications for acute episodes of multiple sclerosis]
1Fédération des Neurosciences Cliniques, Hôpital Pellegrin, CHU de Bordeaux & Laboratoire de Neurobiologie des Affections de la Myéline (EA 2966), Université Victor Segalen, Bordeaux.
Abstract:
The natural history of multiple sclerosis (MS) exacerbations is characterized by a poor outcome in about 70 p. cent of cases. By contrast, the outcome of a first episode of acute optic neuritis (ON) is usually good. However the disability associated with MS bouts and ON requires the use of a specific treatment. Nine randomized controlled clinical trials against placebo performed exclusively for MS exacerbations or acute ON were identified. Corticosteroids or ACTH produced a significant improvement in disability or vision at 30 days and shortened the duration of exacerbations. Longer follow-up clinical trials performed in MS exacerbation were not able to clearly demonstrate a significant effect. In acute ON clinical trials the long term visual outcome was not significantly different after steroid treatment than after placebo but this outcome is usually good. There is some evidence that high doses of intravenous methylprednisolone delay the occurrence of the next relapse, and have a dose-dependent effect on the rate of new lesion formation. There is no convincing evidence of the effectiveness of oral steroids in MS exacerbations but this treatment is associated with an increase relapse rate in ON. Side effects with intravenous methylprednisolone are less severe than with oral mega doses or ACTH.
Insights
Corticosteroids significantly improve outcomes for multiple sclerosis (MS) exacerbations and acute optic neuritis (ON) short-term. However, long-term benefits are less clear, with potential risks for oral steroids in ON.
Area of Science:
- Neurology
- Clinical Trials
- Pharmacology
Context:
- Multiple sclerosis (MS) exacerbations often lead to poor outcomes.
- Acute optic neuritis (ON) typically has a good prognosis but can cause disability.
- Effective treatments are needed for MS and ON relapses.
Purpose:
- To evaluate the effectiveness of corticosteroids and ACTH in treating MS exacerbations and acute ON.
- To analyze short-term and long-term outcomes based on available clinical trials.
Summary:
- Nine placebo-controlled trials investigated corticosteroids/ACTH for MS exacerbations and acute ON.
- Short-term (30-day) improvements in disability and vision were observed with these treatments.
- Longer-term studies showed limited benefits for MS exacerbations, while acute ON visual outcomes were similar to placebo.
- High-dose intravenous methylprednisolone may delay subsequent relapses and reduce new lesion formation.
- Oral steroids lack convincing evidence for MS exacerbations and may increase ON relapse rates.
- Intravenous methylprednisolone has fewer side effects than oral mega-doses or ACTH.
Impact:
- Corticosteroids offer short-term relief for MS and ON relapses.
- Intravenous methylprednisolone shows promise in delaying MS progression.
- Careful consideration of steroid type and administration route is crucial for managing MS and ON.
- Further research is needed to clarify long-term efficacy and optimize treatment strategies.