title: Tolerance of intravenous methylprednisolone for relapse treatment in demyelinating CNS disease.
abstract: BACKGROUND
  In Switzerland, the first course of intravenous steroids for treatment of episodes of demyelinating CNS disease is usually administered in an inpatient setting. We prospectively evaluated short term tolerance of treatment with special emphasis on sleep quality.
  
  
  METHODS
  Patients with a first event of presumed demyelinating disease (CIS), multiple sclerosis relapses (MS) or sub-acute disease progression were treated with a 5-day regimen of intravenous methylprednisolone (IVMP) in our inpatient clinic. Patients' experience was documented by self-report questionnaires including a standardised depression scale (ADSL). Laboratory tests were performed on a routine basis. Fasting glucose, blood pressure and pulse were measured before every infusion. Activity and sleep patterns were analysed by wrist actigraphs during the 5 day infusion period and at follow-up after 1-2 months.
  
  
  RESULTS
  A total of 66 patients participated in the study. Of these, 55 were steroid treatment naïve, and 11 patients, who had received intravenous steroid relapse treatment before, were admitted because of disabling symptoms. Mood disturbances were reported before steroid treatment, however significantly less often at the end of the steroid pulse and during follow-up. Sleep efficiency as measured by wrist actimetry was high before, during and after steroid treatment.
  
  
  CONCLUSIONS
  Therapy was well tolerated without severe side effects in CIS and MS patients. Sleep efficiency was not disturbed. In conclusion there are no obstacles to change from an inpatient to an outpatient setting for the steroid treatment of relapses in MS and CIS, but rare psychotic reactions to steroid treatment are not predictable.
authors.affiliation: Neurology, University Clinic of Internal Medicine, Kantonsspital Baselland, Bruderholz, Switzerland. carmen.lienert@ksbh.ch
authors.forename: Carmen
authors.initials: C
authors.lastname: Lienert
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schawalder
authors.forename: Oliver
authors.initials: O
authors.lastname: Findling
authors.forename: Christian P
authors.initials: CP
authors.lastname: Kamm
authors.forename: Sebastian
authors.initials: S
authors.lastname: Humpert
authors.forename: Anne
authors.initials: A
authors.lastname: Mugglin
authors.forename: Johannes
authors.initials: J
authors.lastname: Mathis
authors.forename: Mathias
authors.initials: M
authors.lastname: Sturzenegger
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D000328:Adult; D000368:Aged; D020278:Demyelinating Autoimmune Diseases, CNS / Q000188:drug therapy*; D003863:Depression / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone