Corticosteroids in the treatment of multiple sclerosis.
BACKGROUND
Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system (CNS) that usually is clinically characterized by repeated subacute relapses followed by remissions. Therapeutic strategies include corticosteroid treatment of relapses and immunomodulatory- or immunosuppressive treatment to prevent new relapses and progression of disability.


OBJECTIVE
To review the evidences for the use of corticosteroids in the treatment of relapses in MS as well as its possible disease modifying potential.


METHODS
Available literature from PubMed search and personal experiences on corticosteroid treatment in multiple sclerosis were reviewed.


RESULTS
High dose short-term oral or intravenous methylprednisolone for 3-5 days speed up recovery from relapses, but the treatment has no influence on the occurrence of new relapses or long-term disability. There is also some evidence that pulsed treatment with methylprednisolone have beneficial long-term effects in multiple sclerosis.


CONCLUSIONS
Relapses with moderate to serious disability should be treated with high dose intravenous or oral methylprednisolone. More data is needed to determine long-term disease modifying effects of corticosteroids.
Myhr
K M
KM
Norwegian Multiple Sclerosis National Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway. kjell-morten.myhr@helse-bergen.no
Mellgren
S I
SI
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016899:Interferon-beta / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000517:prevention & control; D020127:Recovery of Function; D012008:Recurrence
D000305:Adrenal Cortex Hormones; D016899:Interferon-beta; D000324:Adrenocorticotropic Hormone