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Use of glucocorticosteroids in the management of multiple sclerosis relapses

Dagmara Mirowska-Guzel1,2

Affiliation and address for correspondence
Aktualn Neurol 2016, 16 (3), p. 131–135
DOI: 10.15557/AN.2016.0017
Abstract

Multiple sclerosis is a chronic demyelinating disease of the central nervous system. At diagnosis, about 85% of patients with multiple sclerosis have a relapsing-remitting form of the disease. Relapses are the typical multiple sclerosis manifestation, yet their frequency during the disease’s course is variable and unpredictable. Usually at the disease onset relapse symptoms resolve totally, whereas in the later period relapses leave permanent residual neurological deficits. Neurological worsening in the course of multiple sclerosis may have aetiology other than relapse. Recurrence of pre-existing symptoms of multiple sclerosis in the context of infection or stress is termed a pseudo-relapse. Glucocorticosteroids are used to improve neurological recovery after a relapse. In the light of the current knowledge they act exclusively to counteract the symptoms, and do not affect disability progression in long-term observation, nor do they prevent subsequent relapses. The use of glucocorticosteroids is not necessary with every case of neurological worsening. Other reasons for exacerbation or occurrence of symptoms should be excluded, such as infection, stress or disease fluctuation. Benefits and risk, including adverse effects, comorbidities and contraindications should be considered before applying glucocorticosteroids for multiple sclerosis relapses. There is no universal dosing regimen. The article presents general rules for glucocorticosteroid use in multiple sclerosis, discussing its advantages and limitations.

Keywords
multiple sclerosis, relapse, pseudo-relapse, glucocorticosteroids

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