Corticosteroids (commonly referred to as “steroids”) are hormones normally produced in the human body by the adrenal glands. They have a number of physiologic effects on different organ systems, but are most widely used for their anti-inflammatory actions. These steroids are different from the anabolic steroids used by athletes and others to enhance muscle development and strength.
Treatment for MS Attacks
Steroids were among the first agents used to treat MS and remain the treatment of choice for managing acute exacerbations, (also called relapses or attacks). Some steroid medications, such as prednisone, are generally given orally. Others, such as methylprednisolone (Solu-Medrol®) and dexamethasone (Decadron®) are given intravenously (IV).
Not all MS exacerbations require treatment. For any attack that is significantly impacting a person’s ability to function at home or at work, most MS specialists recommend a 3-5 day course of high-dose intravenous steroids. Data from clinical studies suggest that this short course of high-dose, given intravenously, provides maximum benefit with fewest side effects. Although some MS specialists prescribe oral rather than intravenous steroids, the data supporting the use of oral steroids remains controversial at this time.
Most people are able to receive IV treatment on an out-patient basis, either at home or in a doctor’s office. In some situations, hospitalization may be recommended or required. Depending on the physician’s preference, the patient’s condition, and the length of the treatment, the IV steroids may be followed by a one- to two-week taperingdose of oral steroids.
ACTH (adrenocorticotropic hormone), administered by injection, is also a recognized treatment for exacerbations of MS.
Treatment for Optic Neuritis
Studies have shown that a short course of IV methylprednisolone followed by a tapered course of oral steroids may be useful in helping to reverse inflammation and restore vision in optic neuritis, an inflammation of the optic nerve that is often associated with MS. There is, however, no definitive evidence that this treatment produces a more complete recovery than that which would have happened without treatment.
Side Effects of Corticosteroids
Corticosteroids should always be taken under a doctor’s supervision. Possible side effects include stomach irritation, elevation of blood sugar, water retention, restlessness, insomnia, and mood swings. Most patients, however, tolerate the treatment well. Even with short courses of IV steroids, the physician may need to prescribe medications to help the person sleep and minimize stomach discomfort.
Several studies have found that monthly one-day pulses of intravenous methylprednisolone may be helpful in treating patients with active MS. These studies are still preliminary and require larger numbers of patients before making definitive recommendations.
Long–Term Use Is Not Indicated
There is no evidence to suggest that continuous steroid administration slows progression of MS or improves symptoms over a long period of time. The side effects of long-term continuous steroid use are serious and well-documented. These include stomach ulcers, weight gain, acne, cataracts, osteoporosis (thinning of the bones), deterioration of the head of the thigh bone, and chemical diabetes.
Oral steroids that have been taken over a long period of time should never be stopped abruptly, since they can suppress the body's own steroid production by the adrenal gland. Gradually tapering the dose downward before discontinuation of the medication allows the body time to normalize production.