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Steroids

The role of steroids in managing relapses has been accepted for many years. Most neurologists now prescribe steroids for acute relapses for people with relapsing-remitting MS. The evidence seems clear that they shorten recovery time from individual relapses. This contrasts with any of the other agents currently available, none of which appears to have much effect on improving the recovery from an acute relapse. For instance, natalizumab which potently affects the relapse rate in MS has no effect on recovery from an acute relapse.1 What is not so clear about steroids is whether the actual amount of recovery is improved, nor the optimal dose, appropriate route of administration, or whether there is any benefit long term.

‘Steroids’ is the accepted shortening of the term corticosteroids. Steroids in general are found naturally in plants and animals, but corticosteroids are those particular steroids secreted into the bloodstream by the adrenal gland. Many are now also synthesised in the laboratory.

Studies of people with MS relapses who are being treated with steroids show that the steroids work by decreasing the levels of the ‘bad’ immune chemicals and by making the cell membranes of the white cells more pliable and less sticky.2 It is interesting to note how similar this is to the mechanism in which diet and essential fatty acids supplements work, but without side-effects. Other evidence suggests that there is also an effect on the way the brain interprets the messages coming to it from the body’s nerves.3 MRI studies also show that steroids significantly decrease the amount of swelling around individual MS lesions, causing better nerve transmission through these affected areas. These effects are seen on MRI within hours of taking the first dose.

Side-effects of Steroids

Steroids are safe when used in short courses of 5-7 days or less. A few rare cases of bone problems have been reported, but these are exceedingly unlikely. When used continually long term they can cause serious problems including weight gain, fluid retention, increased risk of infection, risk of stomach ulcers, muscle weakness, changes in behaviour including depression or psychosis, cataracts and osteoporosis. Long-term use is not a good idea in any condition, unless there is no real alternative.