Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer
Question: How do you determine when a relapse is severe enough to be treated with IV steroids versus waiting to see if the relapse will go away on its own? Also, if a patient does not receive IV steroids, what other treatments or changes in lifestyle may be recommended for a less-severe relapse?
Answer: Clinicians vary widely in their threshold for using steroids for relapses… and patients vary widely in their desire to be treated with steroids for relapses. The most common use of steroids is for a relapse that interferes with function. For example, severe vertigo, weakness, or gait dysfunction are common symptoms that can greatly interfere with function.
However, it’s important to know what steroids can and cannot do for a relapse. Steroids shorten the recovery period, but do not significantly change the outcome of the relapse. Steroids also have a wide variety of potential side effects, including annoying symptoms such as insomnia… or more severe side effects such as gastrointestinal bleeding and aseptic necrosis of the hip (aseptic necrosis is a serious condition that weakens the bone). So, as with all medications, the potential risks need to be balanced with the potential benefits. In addition, while steroids given orally or intravenously are the most common treatment for relapses, ACTH and plasmapheresis may be used as alternatives in certain instances.
Whether or not steroids are used, relapses are disconcerting. This a time to emphasize rest and stress reduction. Also, it’s important to discuss any relapses that occur, with your clinician, to determine the right course for you. It is a time to consider not just the treatment for the relapse itself, but whether your disease-modifying therapy (DMT) is working optimally. Taking into consideration the severity and frequency of your relapses, your neurologist can advise you on whether or not it is time to consider a different DMT for your MS.
Barry A. Hendin, MD, is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.