Treating Exacerbations with Steroids

Most people with MS experience exacerbations (or MS attacks) which often last from one to three months. Acute physical symptoms and neurological signs must be present for at least 24 to 48 hours — without any signs of infection or fever — before the treating physician may consider it to be a true relapse.

A pseudoexacerbation is a temporary worsening of symptoms, without actual myelin inflammation or damage, which is brought on by external influences — such as infection, exhaustion, heat, depression, or stress. Checking for a fever is important, since even a minor infection can cause old symptoms to reappear. Urinary tract infection (UTI) is the most common illness to cause a pseudoexacerbation. People with "heat-sensitive" MS should avoid hot tubs, saunas, or other situations that can raise the body's temperature. These too can cause a temporary increase in symptoms.

Exacerbations are usually treated with a high-dose, short-term course of powerful steroids (corticosteroids). The goals are to (1) reduce the severity and duration of the relapse by decreasing inflammation, and (2) potentially minimize any permanent damage resulting from the attack. Steroid treatments are often given by IV injection (intravenously), which injects the drug directly into the bloodstream for quick action. In the past, this could only be done in a hospital setting, but now this treatment may be performed in the comfort of one's home.

Long-term use of steroids is not generally recommended. They can cause many side effects when given over a long period of time and may have no effect on the long-term progression of MS.

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