JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Factors affecting response to relapse treatment in multiple sclerosis patients
Abstract
Aims: Relapses, a hallmark of multiple sclerosis, often lead to functional loss and a decline in quality of life. While the accelerating effect of intravenous methylprednisolone treatment on the recovery from multiple sclerosis relapses is well established, the rates of recovery can vary between relapses. This study aimed to evaluate the responses to intravenous methylprednisolone treatment administered during relapses in multiple sclerosis patients and to investigate the clinical factors and imaging characteristics influencing these responses.
Methods: Patients diagnosed with relapsing-remitting multiple sclerosis who presented within the first 3 weeks of the onset of relapse symptoms were included in the study. Along with the patients’ demographic information, disease characteristics, Expanded Disability Status Scale scores during relapses, affected functional systems, and brain and spinal cord magnetic resonance imaging findings were recorded. As relapse treatment, patients were administered 1000 mg/day of intravenous methylprednisolone for 5 days. Expanded Disability Status Scale scores were calculated on the 5th, 15th, and 30th days of treatment. Patients were compared in terms of disease characteristics and imaging findings based on changes in Expanded Disability Status Scale scores before and after treatment on the 30th day.
Results: A total of 50 relapsing-remitting multiple sclerosis patients (13 men and 37 women, mean age 32.5±9.2 years, mean disease duration 4.7±5.3 years) were included in the study. Improvements of varying degrees were observed in half of the patients by the 5th day of treatment and in all patients by the 15th and 30th days. The mean Expanded Disability Status Scale score of the patients before treatment was 3.2±1.0, which decreased to 1.4±0.9 on the 15th day and 0.4±0.6 on the 30th day after intravenous methylprednisolone treatment. In the group with greater improvement (?3-point reduction in Expanded Disability Status Scale) on the 30th day compared to the group with less improvement (<3-point reduction in Expanded Disability Status Scale), the following were observed: higher pre-treatment Expanded Disability Status Scale scores (p<0.001), more frequent involvement of the pyramidal system during relapses (p<0.001), a higher number of patients with cerebellar demyelinating lesions on brain magnetic resonance imaging (p=0.01), and more frequent infratentorial lesion locations (p=0.04).
Conclusion: Our findings demonstrated that symptom improvement on the 30th day of intravenous methylprednisolone treatment was greater than on the 15th day, suggesting that evaluating recovery from relapses before one month may be misleading. Furthermore, it was observed that improvement was more pronounced in relapses accompanied by pyramidal symptoms, which were more severe and disabling.

Keywords : Multiple sclerosis, relapse, methylprednisolone, disability

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1. Berkovich RR. Acute multiple sclerosis relapse. Continuum (Minneap Minn). 2016;22(3):799-814. doi:10.1212/CON.0000000000000330
2. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-286. doi:10.1212/WNL.0000000000000560
3. Lublin FD, Baier M, Cutter G. Effect of relapses on development of residual deficit in multiple sclerosis. Neurology. 2003;61(11):1528-1532. doi:10.1212/01.wnl.0000096175.39831.21
4. Frohman EM, Shah A, Eggenberger E, Metz L, Zivadinov R, St&uuml;ve O. Corticosteroids for multiple sclerosis: I. Application for treating exacerbations. Neurotherapeutics. 2007;4(4):618-626. doi:10.1016/j.nurt. 2007.07.008
5. Repovic P, Lublin FD. Treatment of multiple sclerosis exacerbations. Neurol Clin. 2011;29(2):389-400. doi:10.1016/j.ncl.2010.12.012
6. Repovic P. Management of Multiple Sclerosis Relapses. Continuum (Minneap Minn). 2019;25(3):655-669. doi:10.1212/CON.0000000000000 739
7. Hirst CL, Ingram G, Pickersgill TP, Robertson NP. Temporal evolution of remission following multiple sclerosis relapse and predictors of outcome. Mult Scler. 2012;18(8):1152-1158. doi:10.1177/1352458511433919
8. Miller DM, Weinstock-Guttman B, B&eacute;thoux F, et al. A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations. Mult Scler. 2000;6(4):267-273. doi:10.1177/135245850000600408
9. Filippini G, Brusaferri F, Sibley WA, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev. 2000;2000(4):CD001331. doi:10.1002/14651858.CD001331
10. Tremlett HL, Luscombe DK, Wiles CM. Use of corticosteroids in multiple sclerosis by consultant neurologists in the United Kingdom. J Neurol Neurosurg Psychiatry. 1998;65(3):362-365. doi:10.1136/jnnp.65.3. 362
11. Burton JM, O&rsquo;Connor PW, Hohol M, Beyene J. Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database Syst Rev. 2012;12:CD006921. doi:10.1002/14651858.CD006921.pub3
12. Nickerson M, Marrie RA. The multiple sclerosis relapse experience: patient-reported outcomes from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry. BMC Neurol. 2013;13:119. doi:10.1186/1471-2377-13-119
13. Nos C, Sastre-Garriga J, Borr&agrave;s C, R&iacute;o J, Tintor&eacute; M, Montalban X. Clinical impact of intravenous methylprednisolone in attacks of multiple sclerosis. Mult Scler. 2004;10(4):413-416. doi:10.1191/1352458504ms1068oa
14. Iuliano G, Napoletano R, Esposito A. Multiple sclerosis: relapses and timing of remissions. Eur Neurol. 2008;59(1-2):44-48. doi:10.1159/000109 260
15. Hirst C, Ingram G, Pearson O, Pickersgill T, Scolding N, Robertson N. Contribution of relapses to disability in multiple sclerosis. J Neurol. 2008;255(2):280-287. doi:10.1007/s00415-008-0743-8
16. Kalincik T, Buzzard K, Jokubaitis V, et al. Risk of relapse phenotype recurrence in multiple sclerosis. Mult Scler. 2014;20(11):1511-1522. doi: 10.1177/1352458514528762
17. Ramsaransing GS, De Keyser J. Benign course in multiple sclerosis: a review. Acta Neurol Scand. 2006;113(6):359-369. doi:10.1111/j.1600-0404. 2006.00637.x
18. Amato MP, Ponziani G. A prospective study on the prognosis of multiple sclerosis. Neurol Sci. 2000;21(4 Suppl 2):S831-S838. doi:10.1007/s100720070021
19. Langer-Gould A, Popat RA, Huang SM, et al. Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. Arch Neurol. 2006;63(12):1686-1691. doi:10.1001/archneur.63.12.1686
20. Sellebjerg F, Jensen CV, Larsson HB, Frederiksen JL. Gadolinium-enhanced magnetic resonance imaging predicts response to methylprednisolone in multiple sclerosis. Mult Scler. 2003;9(1):102-107. doi:10.1191/1352458503ms880sr </ol> </div> <p>
Article available in :
Volume 8, Issue 3, 2025
Page : 405-410
https://doi.org/10.32322/jhsm.1608737
Article Information
Received : 28 Ara 2024
Accepted : 13 Nis 2025
Published : 30 May 2025
Corresponding Author :

Fatma Avşar Ertürk: Department of Neurology, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Avşar Ertürk F, Güven B, Güven H. Factors affecting response to relapse treatment in multiple sclerosis patients. J Health Sci Med. 2025;8(3):405-410.

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