Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Neurosciences, Neurosciences & Neurology, Multiple sclerosis, Corticosteroids, Relapse, Treatment, HIGH-DOSE METHYLPREDNISOLONE, INTRAVENOUS METHYLPREDNISOLONE, DOUBLE-BLIND, RANDOMIZED-TRIAL, SHORT-TERM, IV METHYLPREDNISOLONE, ORAL CORTICOSTEROIDS, CONTROLLED PHASE-3, NATURAL-HISTORY, PLASMA-EXCHANGE, Adrenal Cortex Hormones, Adult, Female, Humans, Lactation, Male, Multiple Sclerosis, Outcome Assessment, Health Care, Pregnancy, Pregnancy Complications, Belgian Study Group for Multiple Sclerosis, 1103 Clinical Sciences, 1109 Neurosciences, Neurology & Neurosurgery, 3202 Clinical sciences, 3209 Neurosciences

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.