Steroid therapy in multiple sclerosis. Point of view

Area of Science:

• Neurology
• Immunology

Background:

• Acute exacerbations of multiple sclerosis (MS) significantly impact patient recovery and quality of life.
• Corticosteroid therapy is a cornerstone treatment for MS relapses, but optimal dosing and administration remain areas of investigation.

Purpose of the Study:

• To evaluate the efficacy of high-dose corticosteroid treatment in accelerating recovery from acute multiple sclerosis exacerbations.
• To compare the effectiveness of high-dose corticosteroids versus adrenocorticotropic hormone (ACTH) in MS relapse management.

Main Methods:

• Review of studies examining corticosteroid treatment for multiple sclerosis exacerbations.
• Comparison of outcomes between high-dose corticosteroid administration and adrenocorticotropic hormone.
• Analysis of treatment protocols including intravenous and oral corticosteroid therapies with varying dosages and durations.

Main Results:

• High-dose corticosteroid treatment demonstrates improved recovery rates in acute multiple sclerosis exacerbations.
• High-dose corticosteroids provide more rapid and consistent benefits compared to adrenocorticotropic hormone.
• Short courses of very high-dose intravenous corticosteroids yield the quickest improvements in clinical status and cerebrospinal fluid parameters, particularly for severe exacerbations.

Conclusions:

• High-dose corticosteroid therapy, especially short-term intravenous administration, is highly effective for managing severe and rapidly progressive multiple sclerosis exacerbations.
• A prolonged, slowly tapered oral corticosteroid course (3-4 months) is often necessary and generally well-tolerated, with minimal side effects when administered once daily in the morning.
• Treatment duration and modality should be individualized based on patient response, tolerance, and potential complications.