High-dose intravenous corticosteroids in the treatment of multiple sclerosis.

Abstract

The effectiveness of high-dose intravenous corticosteroid therapy for acute bouts of multiple sclerosis (MS) was evaluated in comparison with the conventional oral prednisolone therapy. Group I comprised 11 cases of MS treated with oral prednisolone, 30-60 mg daily, and group II comprised 16 cases treated with intravenous corticosteroids; 11 cases given 1000 mg of methylprednisolone for the initial 3 days followed by 100 mg of prednisolone, while the remaining 5 were given 100 mg of prednisolone alone. The initial dosage was maintained for 1 or 2 weeks in each group, tailing off with a period of several weeks of oral prednisolone. The clinical status was evaluated using Kurtzke's expanded disability status scale (EDSS) and functional system scale before and 1, 2 and 4 weeks after the initiation of therapy. EDSS score significantly declined from week 0 (before) to weeks 1, 2 and 4 in group II, respectively, whereas no significant decline of EDSS score was observed in group I. The frequency of improvement (0.5 of an increment in EDSS score) in group II was significantly higher than that in group I at weeks 1, 2 and 4. It was thus suggested that high-dose intravenous corticosteroid therapy might be more useful in acute bouts of MS, especially for obtaining an early improvement, than conventional oral prednisolone therapy.