A to Z of MS Steroids

Corticosteroids (steroids) are the standard treatment for a relapse in multiple sclerosis and have been in use since the mid 20th century. ACTH (adrenocorticotrophic hormone) was once the favoured steroid treatment for relapses in MS, but since the 1980s it has generally been replaced by synthetic steroids such as methylprednisolone. Steroids may be prescribed if the symptoms of a relapse are affecting day to day function, for example walking or use of the hands.

How steroids work

It is still unclear exactly how steroids work but they probably act by partly suppressing the immune system and / or by reducing fluid accumulation around the site of nerve damage. Many studies have shown that steroids are effective in speeding up recovery from relapse but make no difference either to the degree of recovery or to the long-term progression of the condition.

How are steroids given?

Treatment may be in hospital or at home and the drug given orally or intravenously. It has been shown that combining steroid therapy with planned multidisciplinary team care is superior to administering drug therapy alone.

The NICE Guideline states that individuals should be offered a course of high dose steroids to be started as soon as possible after the onset of the relapse. This should be either:

• IV (intravenous) methylprednisolone 500mg-1g daily for 3-5 days or
• high dose oral methylprednisolone 500mg-2g daily for 3-5 days

A Cochrane review compared the effectiveness and saftey of oral and intravenous corticosteroid treatments in people with MS. The review found no major differences in clinical outcomes and both treatments appeared to be equally effective and safe.

Side effects and contraindications

In the short-term, the side effects of steroids are usually minor and transient. but may include indigestion, altered mood, altered sleep pattern, increased appetite and a metallic taste in the mouth. Special care is needed for people who have diabetes, and for those with previous gastric problems who may need medication to protect the stomach. Long-term treatment should normally be avoided due to side effects including, weight gain, acne, cataracts, osteoporosis (thinning of the bones), deterioration of the head of the thigh bone and diabetes. The NICE Guideline recommends that courses of steroids be limited to a maximum of three times a year.

References

Barnes D.
Use of steroids in the treatment of relapse.
In: Thompson A, McDonald I. Key advances in the efficient management of multiple sclerosis.
London:Royal Society of Medicine Press;1999.

Craig J, et al.
A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment.
Journal of Neurology Neurosurgery and Psychiatry 2003;74(9):1225-1230.
abstract

Burton JM, et al.
Oral versus intravenous steroids for treatment of relapses in multiple sclerosis.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006921.
abstract

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