What medications, including oral corticosteroids (e.g. prednisone), should I prepare for a potential second attack of myelitis while traveling, given my ongoing leg pain and current nerve pain medication regimen?

Medication Preparation for Travel with History of Myelitis

You should prepare oral prednisone (40-60 mg daily supply for at least 5-7 days) along with your current nerve pain medications, and establish a clear plan for immediate medical evaluation if new neurological symptoms develop during travel. 1

Rationale for Oral Corticosteroid Preparation

Carrying oral corticosteroids is reasonable but should not replace urgent medical evaluation. While guidelines for immune-mediated myelitis recommend high-dose IV methylprednisolone (1-2 g daily for 3-5 days) as first-line treatment for acute transverse myelitis 1, oral prednisone can serve as a bridge therapy if immediate IV access is unavailable during travel. Historical case series demonstrate that oral prednisone combined with other immunosuppressants has shown efficacy in myelitis associated with autoimmune conditions 2, 3, 4.

Specific Corticosteroid Recommendations:

• Carry prednisone 40-60 mg daily (equivalent to approximately 1 mg/kg for average adult) for 5-7 days as emergency supply 1, 5
• Take as single morning dose to minimize HPA axis suppression 5
• This is intended only as temporary measure until you can access IV methylprednisolone at a medical facility 1

Critical Warning Signs Requiring Immediate Medical Attention

Do NOT rely solely on oral steroids if you develop any of the following: 1

• New or progressive bilateral weakness (especially lower extremities)
• Ascending sensory changes or numbness
• New bowel or bladder dysfunction (urinary retention, incontinence)
• Sensory level on trunk examination
• Rapidly progressive symptoms over hours to days

These symptoms mandate immediate hospital evaluation for IV methylprednisolone 1-2 g daily for 3-5 days, with consideration of IVIG or plasmapheresis if inadequate response 1.

Complete Medication Travel Kit

For Ongoing Leg Pain Management:

• Continue your current nerve pain medication (likely gabapentin, pregabalin, or duloxetine based on standard practice) 6, 7
• Carry at least 2 weeks extra supply in case of travel delays
• Keep medications in original labeled containers

Emergency Corticosteroid Supply:

• Prednisone 40-60 mg daily for 5-7 days 1, 5
• Carry prescription documentation explaining medical history
• Consider proton pump inhibitor (omeprazole 20-40 mg daily) for gastric protection if you need to start prednisone 1, 5

Supportive Medications:

• Acetaminophen or NSAIDs for breakthrough pain management 6, 7
• Anti-emetics if nausea develops with high-dose steroids

Pre-Travel Preparation Checklist

Before departure, ensure you have: 1

• Written summary of your myelitis episode (date, spinal level, OCB status, treatment received)
• Contact information for your neurologist
• List of current medications with dosages
• Recent MRI reports if available
• Clear instructions on when to seek emergency care

Important Caveats About OCB-Positive Myelitis

Your OCB-positive status suggests possible underlying demyelinating disease (such as multiple sclerosis or neuromyelitis optica spectrum disorder), which may require different long-term management than isolated transverse myelitis 1. If you have not already done so, ensure you have been evaluated for:

• Aquaporin-4 antibodies (NMO spectrum disorder)
• MOG antibodies
• Complete MS diagnostic workup with brain MRI

This is critical because NMO spectrum disorder may require different acute treatment approaches and prophylactic immunosuppression 1.

Realistic Expectations

Oral corticosteroids alone are unlikely to be sufficient for a true myelitis relapse and should be viewed as a temporizing measure only 1. The standard of care remains high-dose IV methylprednisolone, which has significantly better CNS penetration than oral prednisone 1, 2, 4. Your priority during travel should be identifying the nearest medical facility capable of providing IV corticosteroids and neurological evaluation, rather than relying on self-treatment with oral medications.

Most importantly: Persistent leg pain 6 months after myelitis does not indicate active inflammation requiring corticosteroids 6, 7. This represents neuropathic pain from prior nerve damage, which is appropriately managed with your current nerve pain medications rather than steroids 6, 7.