title: The effect of pulse methylprednisolone plus theophylline treatment on clinical, pulmonary and inflammatory markers in relapses of multiple sclerosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses.
  
  
  METHODS
  Double blind randomized controlled trial.
  
  
  METHODS
  The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5(th) and 30(th) days of the treatment.
  
  
  RESULTS
  Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5(th) day 2.4±1.6; 30(th) day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level.
  
  
  CONCLUSIONS
  There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.
authors.affiliation: Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Pervin
authors.initials: P
authors.lastname: Işeri
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Başyiğit
authors.affiliation: Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Ciğdem
authors.initials: C
authors.lastname: Ozerdem
authors.affiliation: Hospital Pharmacy, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Başyiğit
authors.affiliation: Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Hüsnü
authors.initials: H
authors.lastname: Efendi
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Füsun
authors.initials: F
authors.lastname: Yıldız
keywords: Multiple sclerosis; TNF-alpha; inflammation; theophylline