Treatment for Relapses
The treatment goal for a relapse is to stop the attack in its tracks and bring the individual with MS back to his pre-relapse condition. Most relapses actually resolve on their own, and often, especially in the early stages of the disease, the symptoms disappear once the inflammation has quieted down. It's possible you'll wake up one day and feel like your old self again, but you may also have some residual effects from the relapse, where a few of the symptoms hang on for a while, or perhaps even permanently.
Since most attacks resolve themselves, treating an attack with medication is not automatic. Your physician will try to determine how much the attack is interfering with your life or how severe the attack really is. It's important to keep track of any symptoms or attacks that occur. This record will help you to understand how your body is functioning, and it may also aid your doctor in following your disease course.
Your doctor may prescribe a round of corticosteroids, which have been the mainstay of treatment for the management of acute relapses for many years. Generally, corticosteroids are prescribed for relapses when the symptoms of the attack are impairing your day-to-day routine, such as problems with vision, strength, coordination, or walking.
Steroids are not generally used for maintenance therapy, although studies are under way to see if they may have some long-term benefit on disease progression. Some research suggests that this approach might reduce destruction in the CNS, although more evidence is needed before it can be recommended. Side effects can be adverse when used over a long period of time.
The Lowdown on Corticosteroids
When people hear the word corticosteroids, they often confuse the steroids used for treatment of MS with anabolic steroids, which athletes take to improve stamina and endurance. They are not the same type of drugs.
Corticosteroids are artificial hormones that simulate hormones produced in the human body by the adrenal glands. When used for exacerbations, steroids can reduce inflammation in the CNS, help suppress the immune system's attack on myelin by closing the blood-brain barrier, and even improve electrical conduction. Despite their effectiveness, they do not appear to improve the long-term course of the disease and can actually lose effectiveness if overused. The type of steroid you are prescribed will determine how it is administered. Steroids are either administered orally or through IV infusion. Some common corticosteroids are:
Deltasone (prednisone). A corticosteroid that is generally given orally. Physicians usually slowly taper patients off prednisone and other steroids to avoid any withdrawal symptoms.
Solu-Medrol (methylprednisolone). A corticosteroid that is administered by IV infusion. Solu-Medrol is used for multiple sclerosis in high intravenous doses. It is sometimes followed up with oral prednisone.
Decadron (dexamethasone). A corticosteroid that is usually administered orally but may also be given by IV infusion.
IV infusions of steroids are sometimes given in a hospital on an inpatient basis for the duration of the treatment (three to five days) so that your reaction can be monitored. You can also go to a clinic or an infusion center, where you will be given the medicine while lying down in a bed or reclining in a chair. Arrangements can be made for a nurse to visit your home to administer the treatment, as well.
Sometimes your doctor may instruct you to taper down the dose of a corticosteroid before stopping it completely. Abruptly stopping steroids can cause symptoms such as weakness, dizziness, anxiety or loss of appetite in some people. Be sure to follow your doctor's orders and carefully follow the instructions on the label of your medication.
It's always nice to get tips from others who know what a particular treatment is like. Here are a few that may make your steroid treatments a bit more comfortable:
Before infusion starts:
Drink a lot of water before your infusion. It makes your veins larger and easier to find when the IV line is inserted into your vein.
Corticosteroids can cause stomach irritation if given on an empty stomach. Have a good meal before your treatment and take an over-the-counter stomach acid reducer during the course of your steroid treatment.
Decide ahead of time which arm you prefer to be used for the IV. Depending on how long the treatment lasts, you may have the line in place for up to five days. You may prefer not to have your dominant hand be used for the line.
Relax during the infusion treatments. Bring along a magazine or an iPod to pass the time.
Sometimes the rate at which the medication is being administered may make your face flush or increase your heart rate. You can ask the nurse to slow down the rate of the infusion if you are feeling uncomfortable.
Food may taste strange for a few hours after your treatment. Some people even report a metallic taste in their mouth. Suck on some ice chips and stick to bland foods until the taste goes away.
You might want to limit sweets for a few days as steroids may increase blood sugar levels. Steroids may cause water retention. To reduce bloating, avoid or limit salty foods during treatments.
Solu-Medrol can make you feel anxious, agitated, and irritable, so you might want to stay home and relax rather than plan a day of activity. Steroids may also cause depression.
If steroids cause insomnia, try different techniques to help you sleep or ask your doctor for medicine to help you.
Steroids reduce your immune system's ability to fight infection, so avoid contact with people who have symptoms of colds or other viruses.
For some folks, the corticosteroids work very well and within days they experience relief from their symptoms and have a renewed sense of energy. Quite a few people report that they feel focused and are suddenly ready to do battle with messy garages, thank you notes, and yard work. The goal in using steroids is to have people back on track as quickly as possible, and for many, steroids do the trick.
But drugs don't have the same level of effect for everyone. For some, the steroids fail to have the same benefit and instead, they must wait for the relapse to resolve itself while working with their doctor to manage difficult symptoms. If your relapse is severe and the steroids aren't working for you, your physician may discuss trying another treatment.
Until you've been prescribed steroids, it's hard to predict how your body will react. While some people may feel focused and energetic, others may feel wired and agitated. Steroids are known to cause extreme mood swings that can range from euphoria to depression. A good rule of thumb is to schedule some down time until you learn how you handle a medication.
Corticosteroid Side Effects
You've already learned about some of the side effects of steroids, such as mood swings and water retention. Following is a comprehensive list of side effects:
Weight gain and redistribution of body fat
A weakened immune system (temporarily)
Acne (with prolonged use)
Thinning of the skin (with prolonged use)
Increased blood sugar (hyperglycemia)
Thinning of bones and decreased blood flow to bones (especially with prolonged use)
You may want to troubleshoot potential side effects with your doctor and prepare ahead of time, but keep in mind that not everyone experiences side effects. Your experience may also differ each time you use steroids. Most people tolerate steroid treatment well in short intervals, although long-term use is not recommended because of potential serious side effects.