How do steroids help relapses? In general, steroids are thought to have mostly short-term benefits because they shorten the duration of the inflammatory process and help the patient recover function more quickly. They work by shoring up the blood-brain barrier—to keep stuff out—and deactivating specific immune cells that are attacking myelin. The steroids used to treat MS relapses are corticosteroids that occur naturally in the human body, not anabolic steroids that are sometimes used by athletes and bodybuilders.
Not all relapses are treated with steroids, especially when the symptoms of the relapse are less troubling than the side effects of the steroids. Whether or not to treat is an important decision to make with your healthcare provider. Steroid treatment is generally most effective early in a relapse, before the inflammatory process reaches its peak. The tendency to “wait a few weeks to see if it blows over because I don’t want to bother the doctor” is not a good strategy because, if it doesn’t blow over, you may have missed the window of opportunity for treatment.
Current research supports the use of high doses (1000 mg/day) of either intravenous or an equivalent dose of oral steroids for three to five days, rather than low dose oral steroids. Steroids are contraindicated if someone has some other medical conditions, for example, diabetes. Steroid treatment is not to be undertaken casually because steroids can have many side effects in the short term (insomnia, agitation, irritability, stomach upset and weight gain to name a few) and can cause some serious problems (for example, osteoporosis) long term. However, side effects aside, steroid treatment can have extremely positive benefits for someone in the middle of an immobilizing relapse.
Steroids are thought to influence the rate at which function returns, but probably (in most cases) do not change the amount of function that returns and studies have not found that they alter the long-term disease course of MS. However, for a few patients, for example those who have vertigo or significant visual impairment, they may have an impact on the degree of recovery.
Whether steroids change the overall outcome of MS in the CNS is not the only consideration at hand. While they may not have a lasting effect on what goes on in the brain, they can have a lasting effect on what goes on in life. Returning function more rapidly may make a critical difference in the ability of someone to keep a job or care for kids, and these are equally important considerations.
Steroids aren’t always effective. Sometimes relapses are quite stubborn and don’t respond to an initial course of steroids, so occasionally patients are re- treated with a second round of steroids. Some people don’t seem to derive much benefit from steroids, and some patients report that the benefit of such treatments has diminished over time.
When attacks are really severe a process that “cleans” the blood is sometimes used. In this treatment, known as plasmapheresis, a person’s blood is removed, the plasma portion of it replaced with new plasma, and the “cleaned up” blood is then transfused back into the person. Plasmapheresis is a very invasive and expensive procedure and is generally reserved for catastrophic relapses and when IV steroids have failed.