Corticosteroids

For more than 30 years Corticosteroids have been used to manage MS Relapses, but there is still considerable variation in how and when they are used. 

Corticosteroids, such as Methyl-prednisolone, commonly used by MS patients, are related to Cortisol, a hormone which occurs naturally in the body.  Although they can be effective in hastening recovery from a relapse they do not in any way ‘fix’ the problem and prevent further episodes of MS from occurring. 

During an MS relapse there is a breaking down of the ‘blood brain barrier’ (BBB), so that harmful substances from the bloodstream can cross this barrier and reach the brain and spinal cord.  The steroids are thought to help stabilise the BBB and help close up this leaking.  They also reduce the inflammation in the central nervous system so allowing the brain signals to be transmitted for ‘normal’ body function again.  Corticosteroids are also immunosuppressive.  This means that they reduce the activity of your immune system.  A healthy immune system helps defend your body against bacteria, viruses, and cancer. 

However with autoimmune diseases the immune system goes starts attacking it’s own organs or tissue, in the case of MS this is the myelin sheath which coats the nerves cell fibres in the brain and spinal cord.  In these diseases, Corticosteroids can help by decreasing the harmful autoimmune activity.  However, they also decrease the body's helpful immune activity, which can increase susceptibility to infection and interfere with the healing process. 

During an infusion some people experience a metallic taste in their mouth.  Other short-term side affects can include increased heart rate, hot flushes, a red face, sleeping problems, mood swings, or even a sense of euphoria. 

The long-term use of Corticosteroids can be very harmful, disrupting and weakening the immune system, with the danger of developing Osteoporosis (brittle bone disease) and Osteoarthritis.  Other long-term side effect are weight gain, ‘moon’ face’, muscle wastage, Diabetes, bone fractures, acne, skin bruising, cataracts, peptic ulcers, and wounds taking longer to heal. 

A study concerning steroids & blood cells was conducted at the
Neuroimmunology Unit, Medical School, University of Tampere, Tampere, Finland.

(Summary):
Therapy of acute exacerbations of multiple sclerosis with high-dose intravenous methylprednisolone inhibits the potential transmigration of CCR5-expressing CD4(+) and CD8(+) blood cells into the central nervous system.  This is consistent with the short-term beneficial effect of IVMP in acute exacerbation of MS.

Objectives- Therapy of acute exacerbations of multiple sclerosis with high-dose intravenous methylprednisolone has shortened the recovery period after relapses, but the mechanisms responsible for the beneficial effects of intravenous methylprednisolone in attacks have not been clearly established. 

Our purpose was to analyze the effect of IVMP on the expression of chemokine receptor 5 (CCR5) protein in blood in acute MS exacerbation. 
Materials and methods - Blood samples were collected from 10 patients with an acute MS exacerbation and the levels of CCR5 on CD4(+) and CD8(+) T cells and CD14(+) monocytes were analyzed by using flow cytometry before intravenous methylprednisolone, 24 h, 1 and 3 weeks after commencement of treatment. 
Results -
During the 3-week period the percentages of CCR5-expressing CD4(+) T cells and CD8(+) T cells tended to decrease, but the effect did not reach statistical significance.  No marked changes were found in the percentage of CCR5-expressing CD14(+) cells. 
Conclusions - A tendency to a reduction of CCR5-expressing CD4(+) and CD8(+) blood cells induced by intravenous methylprednisolone suggests inhibition of their potential to transmigrate into the central nervous system, which is consistent with the short-term beneficial effect of intravenous methylprednisolone in acute exacerbation of MS.

Source: pubmed.gov