Steroids
Steroids are used to treat an acute relapse.
In multiple sclerosis (MS), they don’t affect the overall level of recovery, although in related conditions they may do.
Steroids are not often used in purely sensory relapses because they aren’t very effective in this situation.
The dose for:
- IV methylprednisolone is 1g once daily for three days
- oral methylprednisolone is 500mg for five days
The main complication of steroids is avascular necrosis of the femoral head. This is very rare but can lead to needing hip replacement. The risk correlates with the lifetime exposure to steroids, so we prefer to limit the frequency of steroid treatment.
Steroids can be used in pregnancy.
Immunomodulatory treatment
Immunomodulatory treatment (sometimes called disease modifying treatment or DMT), is used to alter the patient’s immune system with the aim of reducing the number of relapses.
There are complex criteria covering which patients are eligible for which treatments, as set out by NHS England:
The patient is not immunosuppressed, but they may be at risk of some specific infections. If there any new symptoms or exposure please contact the MS nurse.
Some of these medications are safe during pregnancy, but not all. We prefer pregnancy to be planned in patients with MS but if the patient finds they are pregnant, please contact their MS nurse.
Symptomatic treatment
Symptomatic treatment are medications that may improve symptoms like spasticity, pain or bladder and bowel dysfunction.
Very rarely, patients with MS are recommended for a bone marrow transplant, this is only the case if all other immunomodulatory treatments have failed.
Last reviewed: 05 September 2024
