Multiple sclerosis (MS) in young people nearly always starts as a “relapsing –remitting” condition. This means that the condition causes symptoms (for example of visual loss, weakness or numbness) that occur for a short period (more than 24 hours) and then gradually improve over weeks to months.
These symptoms come on over hours to days, and are caused by a new immune attack on the central nervous system. On an MRI scan, they may be seen as a new area of “demyelination”. This attack is termed a “relapse”. The period in between attacks is termed “remission”.
Relapses can vary from mild to severe and are unpredictable as to when and where in the central nervous system they will occur. The aim of disease modifying drugs (DMDs) is to prevent these relapses. Unfortunately, even the most effective DMDs cannot prevent every relapse.
How are relapses treated?
Not all relapses need treatment. If the relapse is not affecting day to day function, painful or distressing we would not advise treatment. Steroids should only be given to treat significant relapses. We know they shorten the duration of the symptoms, but do not improve the long-term outcome of a relapse.
How do steroids work, how are they given and are there risks?
Steroids shorten the symptoms by reducing the inflammation around the nerves. They can be given into the vein (infusion) for three days. Sometimes they can be given by mouth (orally). At GOSH, we bring your child in to the Neurology Day Unit for treatment for three consecutive days or, if this is not possible, or they could go to your local hospital.
Steroids, like all medications, have some unwanted effects. In the short term they can affect your mood, may cause difficulty sleeping, and can cause some weight gain and blood pressure problems. If given regularly, they can lead to longer-term problems with thinning of the bones, eye problems and diabetes. For these reasons, ideally infusions of steroids should only be given once to twice a year.