Steroid treatment for relapses in multiple sclerosis - the evidence urges shared decision-making.
OBJECTIVE
Therapy of acute relapses in multiple sclerosis with corticosteroids (CC) remains uncertain with respect to route, dosage and effectiveness. This makes the treatment of relapses a clinical field where 'shared decision-making (SDM)' could be of advantage for the patients. A prerequisite for SDM is the provision of evidence-based information for the patients. The British General Medical Council (GMC) has published ethical guidelines on seeking patients' consent for medical interventions, formulating topics of information patients need in order to make an informed treatment decision.


METHODS
Medical databases were searched for evidence on the treatment of acute relapses with CC.


RESULTS
The available evidence on relapse treatment is ambiguous and weak. It does not provide enough evidence to sufficiently inform patients following the topics formulated by the GMC.


CONCLUSIONS
Good evidence is lacking, supporting the concept of SDM in the therapy of relapses.
Köpke
S
S
Department of Neurology, University Hospital Eppendorf, Hamburg, Germany. sascha.koepke@uni-hamburg.de
Heesen
C
C
Kasper
J
J
Mühlhauser
I
I
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000592:standards*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D010353:Patient Education as Topic / Q000592:standards; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D012306:Risk; D055502:Secondary Prevention; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones