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What is steroid therapy for multiple sclerosis (MS)?

Dr. Louis Rosner
Neurologist

Steroid treatments, both oral and injected, have both favorable and unfavorable effects for multiple sclerosis (MS). They don't always work. They are more likely to work on optic neuritis, brain stem symptoms such as double vision and facial weakness, and spinal cord symptoms in which spastic weakness is the main problem. They work less well for purely sensory attacks and for cerebellar attacks such as tremor, incoordination, and loss of balance. Dramatic effects are seen more commonly in MS cases of fewer than five years. Response to steroid treatments is less dramatic later in the course. 

Common side effects found in the short-term use of steroid treatments include increased appetite, weight gain, water retention, nervousness and insomnia. Less common side effects, unlikely to occur except with prolonged use, include: 

  • Lower resistance to infection, such as activation of dormant tuberculosis. If the patient has a history of TB, anti-TB drugs should be used. 
  • Loss of mineral content from bones, making the patient susceptible to fracture. 
  • Interference with blood supply to certain joints, especially the hip joint. A rare complication known as aseptic necrosis results in the disintegration of the hip or shoulder joint. 
  • Cataracts, reported after years of prolonged use. 
  • Changes in sex hormone levels that result in excess hair growth on the face, arms, and legs, and interference in menstruation. 
  • Aggravation of latent diabetes or worsening of controlled diabetes. 
  • Severe acne. 
  • Thin, fragile skin with easy bruising. 
  • Impaired wound healing. 
  • Increased sweating. 
  • Occasional psychiatric breaks, hallucinations, or delusions. 
  • Convulsions. 
  • Euphoria, a false sense of well-being that can cause confusion in the evaluation of whether or not steroids are indeed beneficial to the patient. The patient may report a dramatic improvement although the examination shows no change. 
  • Increased secretion of stomach acid, which can aggravate and cause bleeding in a preexisting stomach ulcer. If the patient has a history of ulcers, antacids or ulcer drugs should be taken. 
  • Rise in blood pressure.
Multiple Sclerosis

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Multiple Sclerosis

Too often, multiple sclerosis is thought of only as "the crippler of young adults." But in fact, 75 percent of all people with MS will never need a wheelchair. In Multiple Sclerosis, Dr. Louis J....

Steroid therapy is most commonly used for relapse management of multiple sclerosis (MS). Steroids may shorten the duration of relapse symptoms, but do not alter the ultimate outcome of the disease. There are many different regimens used for relapse management. In the United States, intravenous (IV) methylprednisolone or Solumedrol, with or without a prednisone taper, is typical.

In Canada, oral steroids are more commonly used. Studies have shown that oral steroids may be as effective as IV steroids and have similar side effects. Adrenocorticotrophic hormone
(ACTH) is another option for relapse management. This is a hormone that stimulates natural steroid production. The standard protocol calls for a two-week tapering course of intramuscular injections, but shorter doses administered subcutaneously have also been shown to be effective.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.