Although there is no cure for multiple sclerosis (MS), some treatments — including steroids — can help slow the progression of the condition and reduce symptom severity during flares.
Read on to learn more about steroids for MS.
Steroids and MS
Doctors may prescribe steroids for people who experience visual disturbances and other severe symptoms during an MS flare.
A doctor may prescribe intravenous or oral steroids when a person with MS experiences a flare. However, although steroids can be effective for reducing the severity and duration of a person’s symptoms during the flare, they can cause unpleasant side effects.
For this reason, a doctor may only recommend steroids when a person has a severe flare that interferes with their ability to function.
Doctors may be more likely to prescribe a round of steroids for a person with an MS flare if they are experiencing any of the following symptoms:
- visual disturbances
- severe weakness
- extreme balance issues
- difficulty breathing
- severe muscle spasms and cramps
Which types are best?
The steroids that doctors use to treat MS flares are glucocorticoids. These reduce inflammation, which is a trigger for MS symptoms.
Doctors often use glucocorticoids to treat other health conditions in which inflammation plays a role, such as asthma and severe allergy attacks.
For treating MS flares, a doctor will often suggest intravenous methylprednisolone once per day for 3–5 days. Sometimes, they choose to follow the intravenous steroid treatment with steroid pills, which the person will take in a tapering dosage for an additional 1–2 weeks.
In the past, many doctors presumed that intravenous forms of steroids were the best. However, a recent study showed that high dosages of oral steroids are just as effective.
Who should use them?
Healthcare professionals can offer a person with MS advice on whether steroids might be a suitable treatment for them.
Doctors typically use steroids to help a person experiencing a symptom flare. Steroid treatment will help a person with MS recover from the acute symptoms of the flare.
However, steroids do not have a lasting or profound impact on the overall treatment of MS. So, healthcare providers do not consider steroids a primary form of treatment for MS.
Often, the symptoms that a person experiences during a flare will gradually get better on their own. Not everyone who has a flare will require steroids to recover. A person should speak to their healthcare provider to determine whether steroids are a suitable treatment option for them.
It is important to note that people with an active infection should not take steroids. Infections, such as colds or urinary tract infections, can make MS symptoms worse.
Steroids can also make an infection worse, so people should let their doctor know if they are sick before taking steroids.
After treating the infection, MS symptoms may also start to fade.
Dosage
Steroids for MS are available in the form of injections and oral medications.
Although the actual dosages that people take may vary, one study defined high-dose methylprednisolone as higher than 500 milligrams (mg) per day and low-dose as lower than 48 mg per day. It concluded that high dosages, around 500–1,000 mg per day, taken intravenously for 3–5 days are the most effective.
The injectable form of steroids typically comes as a powder that healthcare professionals mix with a liquid. They will administer the injection directly into either a vein or muscle.
The oral form of steroids often comes as a tablet, which a person will need to swallow whole. A person should also take the medication with food to help prevent an upset stomach.
Tablets are much easier for people to take than regularly coming in for appointments to receive an injection.
A person should follow their healthcare provider’s instructions for how long to take steroids for and the dosage they should take. If someone accidentally skips a dose, they should take it as soon as they remember and let their doctor know.
Effectiveness
Steroid injections are reportedly quite effective in high dosages. However, they tend to be more expensive and an unpleasant way to receive medication.
One recent study determined that high-dose oral steroids can be just as effective as injections. Also, they are usually less expensive and offer a more comfortable way to take medication.
Side effects, warnings, and risks
Steroids can cause adverse side effects, including insomnia.
Both oral and injectable steroids come with some risks.
Oral steroids may cause the following side effects:
When taking an oral steroid for MS, a person should call their healthcare provider immediately if they experience any of the following symptoms:
- swollen face, lower legs, or ankles
- skin rash
- vision problems
- a cold or infection that lasts longer than normal
- black or tarry stool
- muscle weakness
Injectable steroids also carry a degree of risk. Some side effects to be aware of include:
- slower healing of cuts and bruises
- headaches
- dizziness
- inappropriate happiness
- depression
- red or purple blotches or lines under the skin
- thin, fragile, or dry skin
- irregular or absent menstrual periods
- extreme tiredness
- acne
- increased body fat
- fat movement to different areas of the body
- skin depressions at the site of injection
- extreme changes in mood and personality
- increased sweating
- hiccups
- difficulty falling or staying asleep
- muscle weakness
- joint pain
- increased appetite
If a person taking injectable steroids notices any of the following symptoms, they should call their healthcare provider immediately:
- vision problems
- numbness, burning, or tingling in the face, arms, legs, feet, or hands
- a sore throat, fever, chills, cough, or other signs of infection
- abnormal skin patches in the mouth, nose, or throat
- sudden weight gain
- seizures
- confusion
- swelling of the face, tongue, eyes, lips, hands, throat, arms, feet, lower legs, or ankles
- difficulty breathing or swallowing
- shortness of breath
- itching
- skin rash
- hives
Some other considerations for people receiving steroid injections include:
- They come with a higher risk of developing cataracts or glaucoma when people receive them for long periods.
- They may stunt a child’s growth.
- They may increase the risk of developing osteoporosis.
- They may cause other unusual side effects.
If people use steroids long-term, they should not stop them suddenly. A doctor and patient can develop a plan to safely taper off the steroids.
Summary
For acute MS flares, steroids are usually an effective treatment option. Typically, people should not take them long-term.
Steroids come in two forms: oral and injectable. Both can be effective in high enough dosages to treat an MS flare.
A person should be aware of potential side effects and call their doctor if they experience any severe symptoms.
