Management Oral Steroids

Data on the effectiveness of oral steroids in the treatment of MS setbacks contradictory. In the study of optic neuritis mentioned above, in the months was observed after treatment, and increase the number of relapses in the group with oral prednisone placebo and treated by MPIV. However, among the experts to examine the results of this study, and there are many who reject the conclusion of the book is that oral prednisone for the subsequent increase in the frequency of relapses.

A recent study showed in Denmark effectiveness of methyl (MP) in the treatment of oral setbacks. Authors compared the effects of oral MP to placebo in patients who have suffered a series of less than 4 weeks. Received twenty-five patients and placebo and 26 500 mg / day given orally for 5 days MP, and cut from 10 days of treatment

Methyl Vein

As seen above, the administration of corticosteroids for a short period is the treatment of acute exacerbations of common MS. Between the different approaches, the intravenous administration methyl (MPIV) the most common, especially because it can be taking the drug over a short period (3 to 5 days per year), and quickly and cause relatively few side effects. Used widely in hospitals and clinics, as well as outpatient clinics. Treatment should be administered under medical supervision, because of side effects, although rare, include psychosis, peptic ulcer, and aseptic bone necrosis, infection, irregular heartbeat, and blood clots.

Some neurologists management periodic MPIV (For example, once a month) in patients who suffer from MS gradual, but is linked to this type of management to increase the risk of side effects and there is no evidence that the data. Changes in the course of the disease

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Oral Treatment

Studies have shown, followed by magnetic resonance imaging (MRI), and the effect of steroids by it shows a decrease in lesion that leads to improved in the presence of gadolinium. However, this effect did not last long, however, and new lesions appear within a week after treatment. If often use corticosteroids in the treatment of advanced, little is known about their optimal dose system. In particular, there is no consensus on the relative effectiveness of various compounds (for example, ACTH intramuscularly, steroids IV or oral steroids), and optimal dose of each track management or the possible need for "oral treatment with low after management IV therapy of short duration continue. MPIV replace some doctors with oral corticosteroids in the treatment of recurrent disease because of the convenience of this type of management and reduce costs. We presented data indicate that the methods are equally effective in acute exacerbations, but it's not very convincing. It is interesting to note that in many of the studies of corticosteroids by mouth (concentrated all forces operating on a relatively small), and different dose regimens. And other anti-inflammatory drugs such as nonsteroidal anti-inflammatory non-steroidal (NSAIDs), and acetylsalicylic acid (aspirin), indomethacin, ibuprofen and naproxen did not prove effective in the treatment of MS acute

Effect of Exacerbations

The recovery rate of vision significantly faster in the group that received treatment with main interest MPIV were in patients whose visual acuity was 20/40 or less established at the outset. After six months there was no significant difference in visual acuity between the groups and the placebo MPIV. Oral prednisone given did not prove superior to placebo. It was surprising that during the month 6-24 follow-up, the risk of optic neuritis was higher repeated in both eyes were in patients treated with oral prednisone and MPIV by about 50 percent. Risk of outbreaks per cent of the new. Diagnosis of MS was the effect was greater in patients with higher risk of recurrence, ie, d. In those with brain lesions multiple MRI at baseline have led these results to the fact that it is not designed this study to evaluate the effect of sugary on exacerbations assessment later and there is no placebo group or protocol blinding for the group that received treatment by MPIV interpretation. Differences between the treatment groups was no longer significant after three years, which shows that the best MPIV slow the progression of MS, but without stopping.

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Exacerbation Vs Corticosteroids

It was found that corticosteroids reduce the duration and severity of relapses and speed recovery, but not beyond a reasonable doubt that the increase of the overall rate of recovery, or that change the course of the disease in the long term.

ACTH (adrenocorticotropic hormone or ACTH) first drug to have proven effective in the recovery of acute exacerbations. Was administered intravenously methyl (IV) over short periods and at high doses (500 to 1000 mg MPIV / day for 3-5 days) ACTH largely because of its reliability, convenience suppress its image improve safety and perhaps put its consistent and faster. The extrapolation of the results of the study on the treatment of optic neuritis (inflammation of the optic nerve primary treatment) by neurologists many MS attacks in general.

In this study, 457 patients were randomly with optic neuritis to 1000 mg / day for 3 days on MPIV, then 1 mg / kg / day. Oral prednisone for 11 days, orally, 1 mg / kg / day of prednisone by mouth for 14 days or placebo feature study cases of inflammation of the optic nerve is the fact that also fits this requirement to assess the parameters sensitive (for example, the visual field, and contrast sensitivity, color vision and visual acuity).

Exacerbation

At least 80 to 85 Percent of people with MS during periods of exacerbation of their symptoms go at one time or another. This is a large, and sometimes worsen, and attacks or crises that bear by the sudden onset of a neurological disorder known for at least 24 hours in the absence of fever or infection. Outbreak of symptoms varies greatly. Layouts magnetic resonance imaging (MRI) taken during deceleration often show new active lesions in the brain (it increases in the presence of gadolinium) or old pest activate or expanded. Although most episodes of spontaneous, most medical professionals agree on the necessity of the treatment if they have important functional implications are.

Corticosteroids are the cornerstone for many years for the treatment of acute exacerbations. Because immune and anti-inflammatory effects, to restore the integrity of the blood-brain barrier to facilitate the return of myelin edema and improve nerve impulses

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When Choosing a Particular Treatment

To consider when choosing a particular treatment (both medical and surgical, rehabilitation or replacement), it is very important that the scientific data on their effectiveness, risks and side effects. This is exactly the direction we set in the writing of this guide, our recommendations are based on peer-reviewed publications of scientific, whenever possible.

Assess the efficiency of treatment is the subject outside the scope of our mission is, in part because it is a parameter difficult to measure and varies depending on the type of management in health care in a particular place. However, we are an exception to this rule in Chapter 5, where we discuss alternative methods of treatment, both because they are not closely related to environmental health care is being run, because these processors are related, and non-medical and often a high price compared with the true benefits .

Completely new compared with previous editions, we have proposed guideline readings (in English) that the reader may consult, if they know more about the treatment, and how they were assessing their effectiveness and safety of the containment.