title: Corticosteroids in the management of acute multiple sclerosis exacerbations.
abstract: Multiple sclerosis (MS) is an autoimmune, inflammatory demyelinating disease of the central nervous system characterized in the majority of the patients by a relapsing-remitting disease course. For decades high-dosage corticosteroids (CS) are considered the cornerstone in the management of acute MS relapses. However, many unanswered questions remain when it comes to the exact modalities of CS administration. In this review on behalf of the Belgian Study Group for MS we define the efficacy of CS in reducing MS-related morbidity and examine whether the effect is different according to type of CS, route of administration, cumulative dosage, timing of initiation and disease course. We also review the use of CS in combination with other MS treatments and during pregnancy and lactation. Furthermore, we delineate the relevant adverse events due to a pulse CS regimen and present a decision tree that can be used when treating MS relapses in clinical practice.
authors.affiliation: Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. ide.smets@uzleuven.be.
authors.forename: I
authors.identifier: http://orcid.org/0000-0001-8174-2898
authors.initials: I
authors.lastname: Smets
authors.affiliation: Department of Neurology, University Hospitals Brussels, Laarbeeklaan 101, Jette, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Van Deun
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49, Louvain, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Bohyn
authors.affiliation: Department of Neurology, Cliniques Universitaires Saint-Luc, Hippokrateslaan 10, Sint-Lambrechts-Woluwe, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: van Pesch
authors.affiliation: Department of Neurology, Hospital AZ Sint-Jan, Ruddershove 10, Brugge, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Vanopdenbosch
authors.affiliation: Neuroimmunological and Rehabilitation Unit, University Hospitals Liège, Avenue de L'Hòpital 1, Liège, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Dive
authors.affiliation: Department of Neurology, University Hospitals Brussels, Laarbeeklaan 101, Jette, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Bissay
authors.affiliation: Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Dubois
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000328:Adult; D005260:Female; D006801:Humans; D007774:Lactation / Q000187:drug effects*; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroids; Multiple sclerosis; Relapse; Treatment