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Steroids for Multiple Sclerosis

When multiple sclerosis symptoms flare, a short course of steroids may be what your doctor prescribes. Typically, steroids are given intravenously for three to five days, and you may be instructed to taper the dose using an oral steroid over one to two weeks. High-dose steroids are used to speed recovery after an MS flare, also known as a relapse. The steroids used for MS are known as corticosteroids, which mimic natural hormones produced in the cortex of the adrenal gland and interrupt inflammation. They're usually well-tolerated when given to treat an MS relapse and the treatment is short-term. Because of long-term complications like bruising, skin changes, and bone changes, we only use them for short periods of time, and it is rare to use them more than once or twice a year. But even in the short term, the medication can have side effects.

How do corticosteroids work?

Corticosteroids have anti-inflammatory properties and are used to control inflammation in many organ systems. Corticosteroids appear to have a range of effects on immune system functions, including inhibition of key immune system cells that play a role in inflammation. Because MS exacerbations or relapses involve nerve damage caused by inflammation in the CNS, the goal of corticosteroid treatment is to control that inflammation and halt acute damage.

How are corticosteroids taken?

Some disagreement among doctors exists as to whether corticosteroids for management of MS exacerbations should be given intravenously or orally. Most neurologists agree that a course of high-dose corticosteroids is the best treatment for a severe MS relapse. One course of corticosteroids will typically involve daily infusions of 1 gram (1000 mg) of Solumedrol given on 3 or 5 consecutive days, either in the hospital or on an out-patient basis.

Usually, a 3-day or 5-day course of high-dose intraveous corticosteroids, often Solu-Medrol which is also known as IVSM, is followed by a course of tapered oral corticosteroids, either Prednisone or Decadron. During this course of tapered corticosteroids, lasting anywhere from 10 days to 5 or 6 weeks, the daily dose starts out high and is gradually decreased every 2 or 3 days. This is necessary because it is dangerous to stop high-dose corticosteroid treatments abruptly.

In the meantime, here are some side effects to watch out for:

1. Sleep Problems

One of the most common side effects from the initial high dose of steroid is sleep disturbance. You may notice trouble falling asleep, have unpleasant dreams, and feel sleepy or fatigued during the day. The following may help you sleep better:

Take your entire dose of steroids in the morning, if your physician approves.
Ask your doctor for a prescription sleep medication.

2. Bad Taste, Upset Stomach

Some people notice a metallic taste in their mouth when undergoing steroid treatment. Sucking on mints or hard candies may help alleviate it. Other common side effects of steroids include upset stomach, nausea, and vomiting. If you experience indigestion or heartburn, ask your doctor to suggest an over-the-counter antacid to help control it.

3. Mood Disturbance

Being on a steroid can make you restless, agitated, and irritable. Agitation is a common symptom for some people. In addition, patients who have a mood disorder may be treated in the hospital to make sure they do not have a serious bout of depression or anxiety. Mood swings with steroid treatment can range from mild to serious. Be sure to tell your doctor if you have a history of depression, anxiety disorder, or bipolar disorder.

It may be a good idea to discuss with your doctor the possibility of keeping a dose of steroids at home in case of a relapse, and also clarifying which symptoms might warrant starting the course. It can take a while to get in to see a neurologist, and the earlier these drugs are started in a relapse, the more effective they are likely to be. Many patients and their neurologists will be comfortable with this approach, although not everyone feels confident enough to decide what exactly constitutes a relapse.