Recommended Prednisolone Dosage in Transverse Myelitis
The recommended treatment for transverse myelitis is high-dose intravenous methylprednisolone at 30mg/kg/day (maximum 1 gram) for 5 days, followed by oral prednisolone taper. 1, 2
Initial Treatment
- Intravenous methylprednisolone should be administered at 30mg/kg/day (maximum dose 1 gram regardless of body weight) once daily for five consecutive days 1
- This high-dose pulse therapy should be given as soon as possible after diagnosis to maximize neurological recovery 2
- Early administration of methylprednisolone in transverse myelitis can significantly reduce morbidity and improve outcomes 1
Oral Prednisolone Taper
- Following IV methylprednisolone, transition to oral prednisolone with a gradual taper 3
- Begin with oral prednisolone at 1-2 mg/kg/day (maximum 60 mg/day) 4
- Taper gradually over 4-8 weeks, reducing by approximately 10 mg every 1-2 weeks initially 5
- When reaching doses below 10 mg/day, slow the taper to 1 mg reduction every 4 weeks to minimize risk of relapse 5, 6
Management of Relapses
- For relapses, return to the previous effective dose that controlled symptoms 5
- After re-establishing control, taper more slowly than initially, not exceeding 1 mg reduction per month 5
- Consider splitting the daily dose for persistent nighttime symptoms when on doses below 5 mg/day 6
Adjunctive Therapy
- For patients with severe disease or inadequate response to steroids, consider adding immunosuppressive therapy such as cyclophosphamide 3
- Cyclophosphamide pulse therapy for approximately 6 months has shown benefit in preventing long-term neurological sequelae in transverse myelitis 3
Monitoring and Follow-up
- Monitor clinical response closely during treatment, with particular attention to motor function recovery 2
- Regular follow-up visits every 4-8 weeks during the first year of treatment to assess recovery and manage potential steroid-related adverse effects 6
- Systematically evaluate for glucocorticoid-related adverse effects, particularly bone mineral density, as prolonged prednisone can cause significant bone loss 6
Expected Outcomes
- Complete recovery can be expected in approximately 40-80% of patients with this regimen 1, 2
- Early treatment is associated with significantly reduced time to independent walking (median 23 days with methylprednisolone vs. 97 days without) 2
- The proportion of patients achieving full recovery within 12 months is significantly higher with high-dose methylprednisolone (80% vs. 10% in untreated historical controls) 2
Cautions
- Monitor for potential adverse effects of high-dose steroids, though serious adverse effects are uncommon with short-term pulse therapy 2
- For patients with comorbidities such as diabetes, osteoporosis, or glaucoma, closer monitoring may be required 6
- Avoid prolonged steroid therapy without appropriate tapering to prevent withdrawal symptoms and adrenal insufficiency 5