Use Of Corticosteroids In Clinical Practice

The beneficial results of high-dose pulse IV MP therapy in systemic conditions like lupus nephritis, glomerulonephritis, and acute transplant rejections prompted the use of high-dose IV MP in the acute relapse of MS. Using double-blind controlled studies, highdose IV MP has been demonstrated to show significant improvement when compared to placebo in patients with MS relapse.

In clinical practice, the use of GCSs should be restricted to MS patients with exacerbations or relapses of functional significance such as visual deterioration, onset of paraparesis, ataxia, bladder dysfunction, and/or loss of manual dexterity. The use of steroids for symptom fluctuations without loss of function should be avoided (Case 1).

Table 6.3 gives the different corticosteroid preparations available with their estimated potency.

GCSs FOR MONOSYMPTOMATIC OPTIC NEURITIS

GCSs have been used for many years to treat monosymptomatic optic neuritis. A multicenter randomized, controlled trial of corticos-teroids in the treatment of acute optic neuritis demonstrated that IV MP (1 gm per day for 3 days followed by oral prednisolone 1 mg/kg, tapered over 11 days) showed greater improvement of visual acuity, visual fields, and colour vision at 2 weeks when compared to oral prednisolone (1 mg/kg per day for 11 days) or placebo. Oral pred-nisolone alone was found to be ineffective and, surprisingly, increased the risk of new episodes of optic neuritis (Case 2).

Nearly 38% to 75% of patients experiencing monosymptomatic optic neuritis later develop clinically definite MS. This is more likely to happen in patients who have at least two periventricular lesions on MRI. In the optic neuritis treatment trial, the post-hoc analyses suggested that clinically definite MS (CDMS) was less likely to develop in IV MP recipients than in oral prednisolone

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