[Steroid therapy in multiple sclerosis]

Abstract

Since the 1950s steroids have been known to have a beneficial effect on recovery from acute exacerbations of multiple sclerosis. The main effect is a more rapid improvement after acute relapses due to resolution of edema in the central nervous system. Long-term steroid therapy showed no benefit in patients with a progressive course and involves dangerous side effects (Cushing's habitus, hyperglycemia, increased susceptibility to infections, peptic ulcers, osteoporosis, cataract). Intrathecal steroid administration offered no advantage over the conventional i.v. route. On the basis of a multicentre trial, ACTH therapy became the standard regime in the treatment of acute exacerbations. Recent reports have demonstrated a beneficial effect of therapy with high-dose methylprednisolone. Taking into account the restrictions and possible side effects, this therapy is a safe and efficient alternative to the standard ACTH regimen in the treatment of acute exacerbations in multiple sclerosis.