Double-Blind Randomized Trial of ACTH versus Dexamethasone versus Methylprednisolone in Multiple Sclerosis Bouts

Milanese, C.; Mantia, L. La; Salmaggi, Andrea; Campi, A.; Eoli, Marica; Scaioli, V.; Nespolo, A.; Corridori, F

doi:10.1159/000116368

Cited by 42 publications

(38 citation statements)

References 15 publications

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“…Additionally, daily administration of 500-1000 mg of MP increases serum steroid peak levels 5-10 times more compared with ACTH administration (54). Despite these, positive effects equivalent to MP have been reported with ACTH use in relapse treatment (59,60,61). This effect is attributed to the direct anti-inflammatory and immunomodulatory effects of ACTH through melanocortin receptors.…”

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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“…Hyperglycemia, hypertension, moon face, and hirsutism were less frequently reported [2,3,[18][19][20][21][22][23][24][25].…”

Section: Adverse Events During Steroid and Acth Therapymentioning

confidence: 96%

“…The low dosages were found to be ineffective [21] and the dosages from 500 mg to 1 g of IV-MP per day became a widely accepted and preferred regiment.…”

Section: Systemic Steroids For Ms Relapse Treatmentmentioning

confidence: 99%

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Treatment of Acute Relapses in Multiple Sclerosis

Berkovich

2016

Translational Neuroimmunology in Multiple Sclerosis

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“…Steroids are widely used in the treatment of MS exacerbations, but is still uncertain if their mechanisms of action are mainly antiedemic [14], antiinflammatory [6] or something else [3,29]. In a previous study, we demonstrated that dexamethazone (DX) is more effective that ACTH or low-dose methylprednisolone (LDMP) in bout therapy [19]. No correlation has been found between clinical efficacy and short-term changes in visual (VEPs) or brain-stem auditory (BAEPs) EPs [26].…”

Section: Introductionmentioning

confidence: 99%

Serial evoked potentials in multiple sclerosis bouts. Relation to steroid treatment

et al. 1994

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Serial recordings of multimodal sensory (visual, acoustic and somatosensory) evoked potentials were made in 19 relapsing-remitting Multiple Sclerosis patients enrolled in a clinical trial designed to evaluate the efficacy of dexamethasone versus high- and low-dose methylprednisolone in acute multiple sclerosis bouts. Electrophysiological and clinical evaluations were performed at the onset of therapy and until 6 months after the end of treatment. Using an arbitrary Evoked Potentials score that takes into account both latency and waveform alterations, we found a positive correlation between evoked potentials and clinical disability scores. Furthermore, different electrophysiological profiles were detected in the three therapeutic subgroups. Evoked potentials may be useful for monitoring acute Multiple Sclerosis bouts and evaluating the effect of therapy.

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Double-Blind Randomized Trial of ACTH versus Dexamethasone versus Methylprednisolone in Multiple Sclerosis Bouts

Cited by 42 publications

References 15 publications

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Treatment of Acute Relapses in Multiple Sclerosis

Serial evoked potentials in multiple sclerosis bouts. Relation to steroid treatment

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