From the Research
A one-time dose of Solumedrol (methylprednisolone) in the Emergency Department can be effective for initiating treatment of an acute Multiple Sclerosis flare-up, but it is crucial to continue with a 3-5 day course of high-dose steroids for optimal management. Typically, a high dose of 500-1000mg IV methylprednisolone is administered as the initial dose 1. The effectiveness of corticosteroids in MS flares stems from their ability to reduce inflammation and suppress the immune response that causes demyelination in the central nervous system, as supported by studies such as 2 and 3. They work by decreasing edema, stabilizing the blood-brain barrier, and reducing the production of pro-inflammatory cytokines. While the initial ED dose helps begin the anti-inflammatory process, the complete steroid course is necessary for optimal management of symptoms and to potentially shorten the duration of the exacerbation. Patients should be advised about potential side effects including insomnia, increased appetite, mood changes, and elevated blood glucose, and should follow up with their neurologist promptly. A recent study 1 compared the effectiveness of two high doses of oral methylprednisolone for MS relapses and found that a lesser high-dose regimen may not be inferior to the standard high dose in terms of clinical and radiological response, which can guide the decision for the continuation of the treatment after the initial ED dose. Key points to consider in the management of MS flares include:
- The importance of early initiation of high-dose steroid therapy
- The need for completion of the full steroid course for optimal symptom management
- The potential benefits and risks of different steroid regimens, as discussed in studies such as 4, 5, and 1
- The importance of patient education on potential side effects and the need for follow-up with a neurologist.