Patient info steroids _2_.doc
Treatment of relapses in multiple sclerosis
Patient Information Leaflet
Relapses in multiple sclerosis (MS) are common and caused by inflammation
in the brain or spinal cord. This causes symptoms the nature of which
depends on the part of the brain or spinal cord affected. The symptoms may
be relatively mild or more obvious and troublesome. For example, a person
may develop blurred vision in one eye when the nerve to the eye becomes
inflamed (known as optic neuritis). Double vision, slurred speech, clumsiness
and/or unsteadiness may develop when a small part of the brain becomes
inflamed (known as brain stem relapse). Leg weakness, numbness or bladder
problems may result from inflammation in the spinal cord (known as partial or
The symptoms caused by a relapse usually develop over a number of days or
weeks followed by a period of stabilisation and improvement over a number of
weeks or months. Following recovery from a relapse, a person may be left
with some residual symptoms (incomplete or partial recovery) or no symptoms
(complete recovery). The periods of stability between relapses are known as
How do I know if I am having a relapse?
If you develop new symptoms that have evolved over a few days or weeks, of
the type commonly experienced in MS, it is likely you are having a relapse.
However, if you develop a recurrence of old symptoms or a worsening of
longstanding symptoms that last only a few hours in duration, or vary on a
day-to-day basis, it is much less likely to be due to a relapse particularly if it
occurs at times of illness or stress. It is important to distinguish these sorts of
symptoms from a relapse in order to avoid inappropriate treatment.
What should I do if I think I am having a relapse?
If you have recently developed symptoms that are particularly troublesome or
causing concern you should contact your MS Nurse (see contact details
below). He/she will be able to assess your condition and give advice with
regard to the most appropriate course of action.
What are the treatment options?
If your symptoms are thought to be due to a relapse and are troublesome it is
appropriate to consider treatment with steroids. If your symptoms are making
it difficult to carry on your normal day-to-day activities, it may be appropriate
to consider referral to local rehabilitation services or even consider hospital
admission. However, if your symptoms are mild and not particularly
troublesome, it is probably best to wait for recovery to occur by itself.
If your symptoms are thought to be due to illness or stress, rather than a
relapse, it is important to avoid treatment with steroids. If there is a concern
you may have an infection, treatment with antibiotics may be needed.
How do steroids work and what are the benefits?
Steroids work by reducing the inflammation that causes relapses. Steroids
may reduce the severity of a relapse and speed recovery. Unfortunately, they
do not usually alter the extent of recovery. Steroids are not usually given for
mild relapses because of the side effects and risks.
What are the side effects and risks?
Steroids often cause a metallic taste, mood change and sleep disturbance. It
is not uncommon to experience a feeling of euphoria or depression. Very
occasionally, a serious paranoid state may be provoked. Steroids may also
cause ankle swelling and a rise in blood pressure and blood sugar levels. If
you already have high blood pressure (hypertension) or diabetes this will need
to be monitored during treatment. Very rarely, steroids may cause serious
damage to the hip (avascular necrosis of the femoral head). Treatment during
pregnancy is probably safe providing steroids are not used repeated as this
It is important to keep the dose of steroids to a minimum. This is because the
frequent and prolonged use of steroids increases the risk of developing long-
term side-effects including diabetes, bone thinning (osteoporosis) and
fractures, muscle wasting, stomach ulcers and infections.
If you have already been taking steroids on a regular basis for more than
a few months it is important to discuss this with your doctor. You
should not to stop treatment abruptly as this may cause serious
How are steroids given?
Steroid can be given either as tablets (usually methylprednisolone 500mg
daily for 5 days) or an intravenous infusion, via a 'drip' into your arm (usually
methylprednisolone 1g daily for 3 days). The infusion takes about 30 minutes.
There is no evidence that one form of steroid treatment is superior to another
in terms of benefits. However, there are other factors that need to be taken
into consideration when deciding which is the most appropriate form of
treatment for you. Oral steroids can be prescribed by your GP but intravenous
steroids are usually given in hospital. If rehabilitation input is required hospital
admission may be needed but this can sometimes be provided locally in the
What happens if I decide not to start treatment with steroids?
You will have the opportunity to ask your doctor and/or MS Nurse questions
about the information in this leaflet before you decide whether or not to start
treatment. If you decide not to start treatment your future care will not be
affected in any way. It is important to appreciate that steroids do not alter the
extent to which you recover from a relapse and declining treatment should not
have a detrimental effect on your condition in the long-term.
Are there any other treatment options?
If you have been having frequent and severe relapses you may benefit from
treatment with beta-interferon or glatiramer acetate. These drugs may reduce
the number and severity of relapses in the short-term. However, the long-term
benefit of these drugs is unknown. Beta-interferon and glatiramer acetate are
suitable for only a minority of people because of their limited benefits and side
effects. Your MS Nurse or local Neurologist will be able to advise whether you
are a potentially suitable candidate for treatment. If it is felt you may benefit
from these drugs you will need be referred by your local Neurologist to Drs
Mottershead or Talbot in the MS Assessment Clinic at Hope Hospital.
Advice about the treatment of relapses
For routine advice
please contact your MS Nurse.
Contact Details for the MS Nurses are as follows;
For emergency medical advice
you should contact your GP or NHS Direct
or the Ambulance Service in case of life threatening concerns.
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living patients from whom tissue has been taken for diagnosis or testing
to use any left over tissue for the following purposes: clinical audit,
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If you object to your tissue being used for any of the above purposes,
please inform a member of staff immediately.'
Hope Hospital operates a smoke free policy. To find out what this means
for you, pick up the leaflets available at the hospital. For advice on
stopping smoking contact 0161 212 4050.
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