Corticosteroids for multiple sclerosis

Examples

Generic Name	Brand Name
dexamethasone
methylprednisolone	Depo-Medrol, Solu-Medrol
prednisone

How It Works

Methylprednisolone, prednisone, and dexamethasone are corticosteroids. These medications shorten multiple sclerosis (MS) attacks by reducing inflammation on the brain and spinal cord.

A high dosage of methylprednisolone may be given through a vein (intravenous, or IV) daily for 3 to 5 days during an MS attack. Prednisone or methylprednisolone may then be given by mouth for several days after the IV treatment.

Why It Is Used

Corticosteroids may be used to treat sudden, severe (acute) MS attacks and acute optic neuritis.

How Well It Works

Treatment with corticosteroids may reduce the symptoms of MS attacks and help you recover more quickly.¹ There is no convincing evidence that corticosteroids can reduce the progression of MS.

For people who have attacks of optic neuritis, IV methylprednisolone seems to be the best treatment.

Treatment with oral prednisone alone may increase the risk of another attack of optic neuritis.²

Side Effects

Corticosteroids cause few side effects when used over a short period of time. People with MS who use a short course of corticosteroids to treat severe symptom attacks may have:

• Sleep problems.
• Anxiety and agitation.
• Depression.

These problems will usually go away once you stop taking the medication.

When corticosteroids are used in high doses or for longer periods of time, they can have more serious side effects, including:

• Weight gain and swelling in the face.
• High blood pressure.
• Blood sugar problems and diabetes.
• Weakening and thinning of bones (osteoporosis).
• Cataracts.
• Bleeding in the stomach and intestines.
• Lowered resistance to infection.
• Death of bone tissue caused by a restricted blood supply to the bones. This is most common in the bones of the shoulders and hips.
• Severe agitation, paranoia, and psychosis (if corticosteroids are used in very high doses).

The side effects that may occur with prolonged corticosteroid use can be a problem for people who have frequent MS attacks and need repeated treatment with corticosteroids.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

The safety of corticosteroids during pregnancy and breast-feeding is not well known. Talk to your doctor if you are planning a pregnancy, if you are pregnant, or if you are breast-feeding.

Intravenous (IV) corticosteroids may work faster and have fewer side effects than oral steroids alone. Treatment with IV methylprednisolone may be followed by treatment with oral prednisone or oral methylprednisolone. Toward the end of the treatment, increasingly lower doses are used so that the body can recover its own ability to produce natural corticosteroid hormones.

Corticosteroid treatment does not work for everyone. In some people who have severe or frequent attacks, corticosteroids are effective at first, but become less helpful after repeated use.

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Author:	Monica Rhodes	Last Updated: February 28, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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