Corticosteroids in the treatment of multiple sclerosis

Background - Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system (CNS) that usually is clinically characterized by repeated subacute relapses followed by remissions. Therapeutic strategies include corticosteroid treatment of relapses and immunomodulatory- or immunosuppressive treatment to prevent new relapses and progression of disability. Objectives - To review the evidences for the use of corticosteroids in the treatment of relapses in MS as well as its possible disease modifying potential. Materials & Methods - Available literature from PubMed search and personal experiences on corticosteroid treatment in multiple sclerosis were reviewed. Results - High dose short-term oral or intravenous methylprednisolone for 3-5 days speed up recovery from relapses, but the treatment has no influence on the occurrence of new relapses or long-term disability. There is also some evidence that pulsed treatment with methylprednisolone have beneficial long-term effects in multiple sclerosis. Conclusion - Relapses with moderate to serious disability should be treated with high dose intravenous or oral methylprednisolone. More data is needed to determine long-term disease modifying effects of corticosteroids.