Irreversible neurological worsening following high-dose corticosteroids in advanced progressive multiple sclerosis

A course of high-dose corticosteroids has been shown to hasten recovery from a relapse of multiple sclerosis (MS). Some patients with progressive MS ask for a course with corticosteroids outside a relapse, hoping to gain some functional improvement.

To describe 4 patients with advanced progressive MS who experienced worsening of disability after treatment with high-dose corticosteroids.

All 4 patients had moderate to severe disability and asked for corticosteroid treatment because they were slowly progressing. None of them had a relapse. All experienced improvement by the end of the treatment course. One or 2 days after discontinuation of treatment, however, they deteriorated clinically and became more disabled than before treatment.

The use of high-dose corticosteroid therapy in progressive forms of MS outside relapses can be detrimental and worsen disability.