What are the effects of steroids in treating multiple sclerosis (MS)?

Steroid treatments, both oral and injected, have both favorable and unfavorable effects. They don't always work. They are more likely to work on optic neuritis, brain stem symptoms such as double vision and facial weakness, and spinal cord symptoms in which spastic weakness is the main problem.

They work less well for purely sensory attacks and for cerebellar attacks such as tremor, incoordination, and loss of balance. Dramatic effects are seen more commonly in multiple sclerosis (MS) cases of fewer than five years. Response to steroid treatments is less dramatic later in the course.

Common side effects found in the short-term use of steroid treatments include increased appetite, weight gain, water retention, nervousness, and insomnia. Less common side effects, unlikely to occur except with prolonged use, include: Lower resistance to infection, such as activation of dormant tuberculosis. If the patient has a history of TB, anti-TB drugs should be used.

Loss of mineral content from bones, making the patient susceptible to fracture. Interference with blood supply to certain joints, especially the hip joint. A rare complication known as aseptic necrosis results in the disintegration of the hip or shoulder joint.

Cataracts, reported after years of prolonged use. Changes in sex hormone levels that result in excess hair growth on the face, arms, and legs, and interference in menstruation. Aggravation of latent diabetes or worsening of controlled diabetes.

Severe acne. Thin, fragile skin with easy bruising. Impaired wound healing.

Increased sweating. Occasional psychiatric breaks, hallucinations, or delusions. Convulsions.

Euphoria, a false sense of well-being that can cause confusion in the evaluation of whether or not steroids are indeed beneficial to the patient. The patient may report a dramatic improvement although the examination shows no change. Increased secretion of stomach acid, which can aggravate and cause bleeding in a preexisting stomach ulcer.

If the patient has a history of ulcers, antacids or ulcer drugs should be taken. Rise in blood pressure.

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