Steroids for MS Relapse: Benefits and Side Effects

Nobody with relapsing-remitting MS wants to wake up facing a new flare-up (aka relapse, attack, or exacerbation). The pain, dysfunction, and disability that it can bring are no joke.

In cases when flare-up symptoms are acute (sudden) and severe, neurologists may prescribe a course of corticosteroids. These drugs are more commonly referred to as steroids.

What are steroids? How do they work? What are their benefits, effects, and alternatives? And can people with progressive MS use steroids?

The role of steroids in MS treatment

When you’re put on steroid therapy for a flare-up, it is to reduce the inflammation endangering your central nervous system (CNS). The immune system may be attacking the myelin coating on nerve cells, causing permanent damage and disease progression.¹

Most neurologists treat major MS relapses right away because they cause pain, disability, and dysfunction. However, minor flare-ups may inspire a “wait and see” approach. Timing matters.¹

It’s also critical to differentiate between an actual relapse and a pseudo-relapse.

Sometimes new MS symptoms don’t indicate new disease activity. This is often the case following periods of stress, high heat, or high activity. Sudden symptoms, even when uncomfortable, aren’t always a relapse. With a pseudo-relapse, a steroid treatment may not have benefits but instead invite a host of unwanted side effects.²

What are steroids?

The human body makes endogenous steroids in the adrenal glands to regulate hormone production. Human-made (exogenous) steroids are synthesized versions of these. Generally, steroids reduce inflammation and suppress the immune system, 2 useful features for people with MS.^3,4

Typically, you will have blood and urine tests prior to treatment to rule out infection (especially bladder infection) before starting steroids.^3,4

Along with steroids, you may also receive prescriptions for other medications to reduce side effects. They are also safe to use while taking disease-modifying therapies (DMTs).^1,4

IV steroids

Methylprednisolone (SoluMedrol®) is given directly in the vein via an IV drip. A typical regimen occurs over three to five days, though sometimes it is administered in a single dose. Treatment may also include tapering* to oral steroids over a period of time.^1,4

Oral steroids

Prednisone delivers steroids in pill form. Research shows oral steroids may be effective in place of IV steroids. Dose amount depends upon the severity of the relapse. A low-dose approach may bring easier recovery for some.¹

Pulse steroids

Pulse steroids describe an on-and-off treatment that involves daily IV therapy for a few days every few months, often with a taper. Some people with MS use pulse steroids along with DMTs, while others may succeed with pulse steroids alone.⁴

Are steroids the right choice for you?

Maybe. If your symptoms interfere with daily function and ability, steroids could help.

The potential benefits and risks for using steroids depend upon:^1,2

• The nature and severity of the relapse
• Treatment alternatives
• Other major medication concerns

However, while steroids can bring much-needed relief, certain groups may need to proceed cautiously, such as people with:^1,2

• Diabetes or glucose intolerance
• Labile hypertension
• Peptic ulcer
• Psychiatric disorders
• Pregnancy

Also, people taking warfarin sodium (Coumadin®) should be closely monitored.¹

The benefits of steroids

A major benefit of steroids is inflammation reduction in the CNS. Inflammation causes many unpleasant symptoms, including spasticity, pain, and reduced bladder control.^2,5

Steroids are especially helpful in shutting down an inappropriate immune system response by closing off its access to the CNS through the blood-brain barrier.⁶

Potential side effects of steroids

As with any medication, steroids can bring unpleasant side effects.⁴

Potential short-term side effects

• Body temperature fluctuations
• Flushing
• Higher blood sugar
• Increased infection risk
• Insomnia
• Metallic taste in mouth
• Mood changes
• Rapid pulse and high blood pressure
• Stomach irritation
• Vision changes
• Weight gain (and related stretch marks)

Potential long-term side effects

• Cataracts
• Changes in facial shape (“moon face”)
• Diabetes
• Hypertension
• Irregular heartbeat
• Joint problems
• Menstrual problems
• Osteoporosis
• Slow healing from infection

Everyone is different. Some will experience several of these, while others may feel no side effects or only mild ones.

Does type of MS matter?

People with relapsing-remitting MS are the chief targets for steroid treatment because their sudden, severe symptoms may lead to disability. But people with primary or secondary progressive MS may also find relief from steroids.⁷

Alternatives to steroids

Sometimes, steroids are not the right option for someone with MS. In those cases, alternatives may include:^1,5

• ACTH (Acthar® Gel
• IV dexamethasone (Decadron®)
• Plasmapheresis

The bottom line

Ultimately, it is best to manage expectations when it comes to steroid therapy. Steroids provide only short-term relief from MS symptoms. While their use can shorten relapses, they do not provide long-term protection or change disease progression. And they do have side effects to consider.¹

*Tapering describes the slow decrease in medication dosage to prevent withdrawal symptoms.