Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Intrathecal versus systemic corticosteroids in the treatment of multiple sclerosis: results of a pilot study


Fifty patients with multiple sclerosis were treated either by corticosteroids given systemically or by intrathecal injection of a steroid crystal suspension. Before and 3 weeks after the beginning of the treatment we examined the patients according to the Expanded Disability Status Scale (EDSS). Four patients had to be excluded from evaluation. In 23 patients the examination revealed at least a small improvement in their disability status. There were 7 intrathecally and 5 systemically treated patients whose disability was significantly reduced. One patient under intrathecal treatment showed a minor deterioration in disability. There was no clear difference in the frequency of improved symptoms or in EDSS scores between the two therapies.

This is a preview of subscription content, log in to check access.


  1. 1.

    Abel R Jr, Nelson DA, Bernat JL (1977) Complications from methylprednisolone acetate (Depo-Medrol). Del Med J 49: 331–343

  2. 2.

    Baker AG (1967) Intrathecal methylprednisolone for multiple sclerosis: evaluation by a standard neurological rating. Ann Allergy 25:665–672

  3. 3.

    Beck RH (1967) Polarizing solution and intrathecal methylprednisolone acetate in multiple sclerosis: follow-up study. J Am Osteopath Assoc 66:664–666

  4. 4.

    Bernat JL (1981) Intraspinal steroid therapy. Neurology 31: 168–171

  5. 5.

    Bernat JL, Sadowsky CH, Vincent FM, Nordgren RE, Margolis G (1976) Sclerosing spinal pachymeningitis. J Neurol Neurosurg Psychiatry 39:1124–1128

  6. 6.

    Boines GJ (1963) Predictable remissions in multiple sclerosis. Del Med J 35:200–202

  7. 7.

    Boines GJ (1969) The management of the multiple sclerosis patient. Behav Neuropsychiatry 1:29–32

  8. 8.

    Buskirk C van, Poffenbarger AL, Capriles LF, Idea BV (1964) Treatment of multiple sclerosis with intrathecal steroids. Neurology 14:595–597

  9. 9.

    Cohen FL (1979) Conus medullaris syndrome following multiple intrathecal corticosteroid injections. Arch Neurol 36:228–230

  10. 10.

    Dougherty JH, Fraser RAR (1978) Complications following intraspinal injections of steroids. J Neurosurg 48:1023–1025

  11. 11.

    Goepel W, Bertram W (1971) Erfahrungen mit der intrathekalen Glukokortikoidtherapie bei entzündlichen neurologischen Erkrankungen (Bericht über 35 Fälle). Z Arztl Fortbild (Jena) 65:99–103

  12. 12.

    Goldstein NP, McKenzie BF, McGuckin WF (1962) Changes in cerebrospinal fluid of patients with multiple sclerosis after treatment with intrathecal methylprednisolone acetate: a preliminary report. Proc Mayo Clin 37:657–668

  13. 13.

    Goldstein NP, McKenzie BF, McGuckin WF, Mattox VR (1970) Experimental intrathecal administration of methylprednisolone acetate in multiple sclerosis. Trans Am Neurol Assoc 95:243–244

  14. 14.

    Haack D, Weik U, Thal H-U, Rauhut, Clar H, Umlauf B (1984) Vergleichende Untersuchungen über die Konzentrationen synthetischer Kortikosteroide im Plasma, Liquor cerebrospinalis und im Hirngewebe. Prakt Notfallmed 2:39–46

  15. 15.

    Hauser SL, Dawson DM, Lehrich JR, Beal MF, Sherwin VK, Propper RD, Mills JA, Weiner ML (1983) Intensive immunosuppression in progressive multiple sclerosis. N Engl J Med 308:173–180

  16. 16.

    Hennes A, Rohrbach E, Kappos L, Staedt D, Kaiser D, Dommasch D, Mertens HG, Haack D (1989) Intrathekale vs orale Corticosteroid-Therapie spinaler Symptome bei Multipler Sklerose — eine Doppelblindstudie. Schweiz Arch Neurol Psychiatr 140:183–184

  17. 17.

    Henn R, Emser W, Schimrigk K (1989) Evozierte Potentiale unter intrathekaler und systemischer Kortikosteroid-Therapie bei Multipler Sklerose. EEG-EMG 20:88–91

  18. 18.

    Hielscher H (1981) Akute Schübe der multiplen Sklerose. Med Welt 32:185–188

  19. 19.

    Holzer G (1983) Zytologische Befunde unter intrathekaler Kortisontherapie bei MS. Psycho 9:400–401

  20. 20.

    Hopf HC, Besser R (1983) Neurologische Komplikationen nach intrathekaler Applikation von Medikamenten. Verh Dtsch Ges Neurol 2:146–157

  21. 21.

    Kamen GF, Erdman GL (1953) Subdural administration of hydrocortisone in multiple sclerosis: effect of ACTH. J Am Geriatr Soc 1:794–804

  22. 22.

    Kappos L, Mertens H-G (1987) Neurologische Erkrankungen. In: Kaiser H (ed) Cortisonderivate in Klinik und Praxis, 8th edn. Thieme, Stuttgart, pp 164–178

  23. 23.

    Kappos L, Krauseneck P, Dommasch D, Damm W, Bogdahn U, Mertens H-G (1985) Verträglichkeit von Triamcinolon-Acetonid-Kristallsuspension und Antibiotika bei intrathekaler Applikation. Verh Dtsch Ges Neurol 3:505–508

  24. 24.

    Kurtzke JF (1981) A proposal for a uniform minimal record of disability in multiple sclerosis. Acta Neurol Scand 64:110–129

  25. 25.

    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

  26. 26.

    Kurtzke JF (1984) Disability rating scales in multiple sclerosis. Ann NY Acad Sci 436:347–360

  27. 27.

    Massaro AR (1978) Modifications of the cerebrospinal fluid IgG concentrations in patients with multiple sclerosis treated with intrathecal steroids. J Neurol 219:221–226

  28. 28.

    Mazzarello P, Poloni M, Piccolo G, Cosi V, Pinelli P (1983) Intrathecal methylprednisolone acetate in multiple sclerosis treatment. Acta Neurol Belg 83:190–196

  29. 29.

    Nelson DA (1988) Dangers from methylprednisolone acetate therapy by intraspinal injection. Arch Neurol 45:804–806

  30. 30.

    Nelson DA, Vates TS, Thomas RB (1973) Complications from intrathecal steroid therapy in patients with multiple sclerosis. Acta Neurol Scand 49:176–188

  31. 31.

    Neu I (1982) Intrathekale Gabe eines Depot-Kortikosteroids. Münch Med Wochenschr 124:67–68

  32. 32.

    Neu I, Reusche E, Rodiek S (1978) Endogener Cortisolspiegel nach intrathekaler Gabe von Triamcinolon-acetonid bei neurologischen Erkrankungen. Dtsch Med Wochenschr 103:1368–1370

  33. 33.

    Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

  34. 34.

    Ringer WA (1968) The treatment of multiple sclerosis with intrathecally administered methylprednisolone acetate. J Indiana State Med Assoc 61:1213–1215

  35. 35.

    Rivera VM (1981) Intraspinal steroid therapy. Neurology 31:1060–1061

  36. 36.

    Rivera VM (1989) Safety of intrathecal steroids in multiple sclerosis. Arch Neurol 46:718–719

  37. 37.

    Rocchelli B, Poloni M, Mazzarello P, Piccolo G, Delodovici M, Pinelli P (1982) Intrathecal methylprednisolone acetate in multiple sclerosis treatment: effect on the blood-CSF barrier and on the intrathecal IgG production. Ital J Neurol Sci 2:119–126

  38. 38.

    Rodiek SO, Neu I (1979) Klinische Erfahrungen mit intrathekaler Gabe von Triamcinolon-Acetonid bei neurologischen Erkrankungen. Therapiewoche 29:1123–1126

  39. 39.

    Rohrbach E, Kappos L, Städt D, Hennes A, Kaiser D, Schmidt S, Dommasch D (1987) Intrathekale vs. orale Kortikosteroidtherapie von spinalen Symptomen bei multipler Sklerose (eine kontrollierte Doppelblindstudie). Verb Dtsch Ges Neurol 4:410–411

  40. 40.

    Rohrbach E, Kappos L, Städt D, Hennes A, Kaiser D, Schmitt D, Haack D, Mertens HG (1988) Effects, side-effecs and pharmacokinetics of intrathecal vs. oral corticosteroids in spinal symptoms of multiple sclerosis: results of a double-blind controlled trial. J Neurol 235 [Suppl]:40–41

  41. 41.

    Rohrbach E, Kappos L, Städt D, Kaiser D, Hennes A, Dommasch D, Mertens HG (1988) Intrathecal versus oral corticosteroid therapy of spinal symptoms in multiple sclerosis: a doubleblind controlled trial. Neurology 38 [Suppl 1]:256

  42. 42.

    Sachs L (1984) Angewandte Statistik, 6th edn. Springer, Berlin Heidelberg NewYork

  43. 43.

    Schmidt E (1967) Erfahrungen mit der intrathecalen Corticosteroidbehandlung der Polysklerose und anderer neurologischer Erkrankungen. Psychiatr Neurol Med Psychol 19:152–156

  44. 44.

    Schock G, Wieczorek V (1974) Meningitis nach intrathekaler Applikation von Kortikosteroiden. Psychiatr Neurol Med Psychol 26:477–479

  45. 45.

    Sehgal AD, Gardner WJ (1963) Place of intrathecal methylprednisolone acetate in neurological disorders. Trans Am Neurol Assoc 88:275–276

  46. 46.

    Sehgal AD, Tweed DC, Gardner WJ, Foote MK (1963) Laboratory studies after intrathecal corticosteroids. Arch Neurol 9:74–78

  47. 47.

    Vito SJ de, Mannarelli AA (1966) Polarizing solutions and intrathecal methylprednisolone acetate in therapy of multiple sclerosis: preliminary study. J Am Osteopath Assoc 65:713–722

  48. 48.

    Wilkinson H (1989) Dangers from methylprednisolone acetate therapy by intraspinal injection. Arch Neurol 46:721–722

Download references

Author information

Correspondence to Reinhard Heun.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Heun, R., Sliwka, U., Rüttinger, H. et al. Intrathecal versus systemic corticosteroids in the treatment of multiple sclerosis: results of a pilot study. J Neurol 239, 31–35 (1992).

Download citation

Key words

  • Multiple sclerosis
  • Corticosteroids
  • Intrathecal treatment