More than 30 years ago, after performing myelograms to rule out tumors, we found that the spinal cord was swollen during severe attacks of MS, causing paralysis. When CT scans of the brain and orbits became available to study patients with severe attacks of optic neuritis, we also found the optic nerves to be markedly swollen. We reasoned that with high doses of steroids we should be able to reduce the swelling in the spinal cord and optic nerve to prevent further damage from the lack of circulation in the affected areas of the ner
Myelogram x-ray studies of the spinal cord and spinal canal performed by the injection of contrast media. CT and MRI studies have replaced this procedure.
vous system. High-dose steroids did seem to work, often more quickly than with ACTH. However, many more side effects were found in patients with the use of high-dose steroids than with ACTH, which somewhat dissuaded us from using this form of treatment. Many neurologists favor the use of steroids as being convenient, disregarding the lack of adequate controlled trials in MS.
The optic neuritis trial of IV methylprednisolone (Medrol) appeared to validate the use of a high dose (1 gram per day) as effective in speeding recovery. Oral steroids, in contrast, did not accelerate recovery; their use resulted in a relapse rate that was twice as high in that trial. Although many neurologists have rationalized their prescription of oral steroids because of fatigue reduction and often restoration of a sense of well-being, they ignore a potentially higher post treatment relapse rate. Oral steroids have not been demonstrated in any adequate trial to be useful treatment for optic neuritis or other MS relapses.
Was this article helpful?