Steroids for MS Relapse

Steroid treatments for MS exacerbations are typically given intravenously (methylprednisolone) and typically over three to five consecutive days. This can be given in an outpatient setting or possibly as a home infusion, as determined by your insurance coverage and your comfort level. In some cases, we may choose to repeat infusions or choose to treat with high-dose pulse oral steroids instead.

Possible Short Term Side-Effects:

  • Metallic taste in mouth during and possibly after infusion
  • Stomach upset, which in severe cases, can result in ulcers, bloody or black stools
  • Sleep disturbance (insomnia, sleepiness/fatigue)
  • Increased appetite
  • Water retention, swelling in hands, ankles, feet or rapid weight gain
  • Mood disturbance/unusual behavior;
  • Muscle cramps, back pain
  • Headaches
  • Allergic reaction

How to Minimize Side-Effects:

  • Bring a few hard candies or mints with you to your infusion appointment
  • Avoid excessive salt intake
  • Watch what you eat, many patients experience weight gain with increased appetite
  • Use Ranitidine, available over the counter, to protect and relieve your upset stomach
  • A prescription sleep aid is available, if needed
  • Optional prescription for oral steroid (prednisone) taper after IV steroids:
    • This is a one to two week course of oral steroids (prednisone), and is recommended to be used under the following circumstances: 
      • You tolerated IV steroids well, but after stopping them you feel unwell, achy (“crash”)
      • You tolerated steroids well and your symptoms improved, but after stopping steroids some of your symptoms reoccurred
    • In either of those circumstances the one to two week oral taper of steroids may help to ease some symptoms, but it is not known that it will benefit you in the long run.  

Important things to remember about an MS exacerbation:

  • Not every exacerbation has to be treated
  • We have time to intervene, as steroids are thought to be most effective when given up to 14 days after symptoms started
  • Steroids can shorten the duration of symptoms, but generally do not impact how much you recover to your previous baseline. 
  • In a typical exacerbation the majority of recovery will take place six weeks after your symptoms peak. This is with or without steroids.
  • Maximum recovery will likely take three to six months with slow, continued improvement of symptoms.
  • There may be residual long-term symptoms from each relapse, and it is important to prevent such relapses in the future because of this.

Download What to Expect: IV Steroids (PDF)