Treatment of Acute MS Exacerbation
During severe acute relapse,
MS patients are usually given high doses of corticosteroids intravenously. The most common
course of treatment is a 3 to 5 day course of intravenous corticosteroids, which
may be followed by a gradually tapering dose of an oral corticosteroid such
as predisone. Steroids drugs act to decrease acute inflammation in the CNS.
Patients often report feeling better when taking steroids, in part due to the
mood elevating effect of the drugs. However, there are serious complications
associated with the long term or chronic use of steroids, including hypertension,
diabetes, osteoporosis, cataracts, and gastric ulceration.
Although the patient with
an acute MS relapse may require an in-hospital stay of several days, a patient
with complications such as sepsis or pneumonia may require a longer hospital
stay and may need rehabilitation to regain his or her full functional potential.
Nickerson and Marrie (2013) examined self-reported data from 4482 participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding evaluation, treatment, and recovery from relapses. "Overall, patients with relapsing multiple sclerosis who receive treatment report better outcomes than those who are simply observed. However, a sizeable percentage of patients feel that their symptoms following corticosteroid treatment are worse than pre-relapse symptoms and that treatment had no effect or worsened symptoms."
Among NARCOMS patients who responded to questions about their most recent relapse:
- 32% of intravenous methylprednisolone (IVMP) treated patients indicated their symptoms were worse one month after treatment than pre-relapse
- 34% of oral corticosteroid-treated patients indicated their symptoms were worse one month after treatment than pre-relapse
- 39% of observation-only patients indicated their symptoms were worse one month after treatment than pre-relapse
- 30% of IVMP-treated patients indicated their treatment made relapse symptoms worse
Reference
Nickerson M., Marrie R.A. (2013) The multiple sclerosis relapse experience: patient-reported outcomes from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. BMC Neurol. 2013; 13: 119.
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