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Corticosteroids in the management of acute multiple sclerosis exacerbations

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Abstract

Multiple sclerosis (MS) is an autoimmune, inflammatory demyelinating disease of the central nervous system characterized in the majority of the patients by a relapsing-remitting disease course. For decades high-dosage corticosteroids (CS) are considered the cornerstone in the management of acute MS relapses. However, many unanswered questions remain when it comes to the exact modalities of CS administration. In this review on behalf of the Belgian Study Group for MS we define the efficacy of CS in reducing MS-related morbidity and examine whether the effect is different according to type of CS, route of administration, cumulative dosage, timing of initiation and disease course. We also review the use of CS in combination with other MS treatments and during pregnancy and lactation. Furthermore, we delineate the relevant adverse events due to a pulse CS regimen and present a decision tree that can be used when treating MS relapses in clinical practice.

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Authors and Affiliations

  1. Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    I. Smets & B. Dubois

  2. Department of Neurology, University Hospitals Brussels, Laarbeeklaan 101, Jette, Belgium

    L. Van Deun & V. Bissay

  3. Department of Radiology, University Hospitals Leuven, Herestraat 49, Louvain, Belgium

    C. Bohyn

  4. Department of Neurology, Cliniques Universitaires Saint-Luc, Hippokrateslaan 10, Sint-Lambrechts-Woluwe, Belgium

    V. van Pesch

  5. Department of Neurology, Hospital AZ Sint-Jan, Ruddershove 10, Brugge, Belgium

    L. Vanopdenbosch

  6. Neuroimmunological and Rehabilitation Unit, University Hospitals Liège, Avenue de L’Hòpital 1, Liège, Belgium

    D. Dive

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On behalf of the Belgian Study Group for Multiple Sclerosis

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Smets, I., Van Deun, L., Bohyn, C. et al. Corticosteroids in the management of acute multiple sclerosis exacerbations. Acta Neurol Belg 117, 623–633 (2017). https://doi.org/10.1007/s13760-017-0772-0

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