Oral steroids Vs IV for a relapse

[Meaganj]

My "diagnosis" is "Probable MS" (basically, its nothing else but they just havent been able to see the lesions yet on an MRI). I am in a relapse now and my GP Rx'ed me Prednisone oral steroids for the relapse. Everyone I know with MS, including my sister, gets IV steroids for a relapse. It's been 2 days on the prednisone and no real change in my symptoms- weakness in legs, uncoordination in hands, head tremor, cognitive probs, gait changes... Should I be taking IV steroids? Do they even Rx oral steroids for MS relapses? Please help!!

Meagan

[tennislady321]

Hi, I was switched to oral steroids (not a big dose either) for several days after I had a strong reaction on day two of IV. I don't know if it was the combo or the oral but it did get rid of my neuro ms symptoms. I felt no side effects from the IV but had euphoria, tons of energy and then a crash on orals. Did not have another relapse for 11 years. Just had my first IV steroids today in eleven years, my doctor is trying one day a month for three months to see if it helps my symptoms that have not remitted in the last two years since the first attack after eleven years. After the IV today I feel calm and relaxed - not at all what I expected. So not only is everyone different on steroids the same person may have different reactions and respond differently on IV than on orals. Good luck!

[Meaganj]

Well, since I am not officially diganosed, they are not willing to give me IV steroids. So I am taking the prednisone and feeling, well...not worse, but not really better. Still can barely walk, cognitive stuff, but my head stopped tremoring. I have to look on the bright side!! I get the results from my MRI tomorrow. I went to Providence St V's per what Quix wrote about the software. Thank you for the education, Quix. Much appreciated.

It's just frustrating that everyone around is saying "yeah you probably have MS, but its just too early to see lesions". So why isn't anyone trying to Treat me?? I work in health care and to be on this side of the fence is so different. It's like i give up all my power walking into a Doctor's office.

Sorry, just frustrated :(

Meagan

[shermay]

I took oral Medrol back in July.  I had 500g per day for 5 days. It had to be the worst experience ever - normally I have IV, BUT my all seeing Neuro:( said that it had been proven that oral medrol had the same effect as Solumedrol.

My experience with oral was that as the tablets disolved the effect was horrendous, compared to an IV which slowly gives you the meds.

I told him in no uncertain terms that I would not wish medrol on my worst enemy!!!

Debs

[Quixotic1]

Okay.  I forgot my own rule.  There are no rules.

If the oral steroid help, then they help.

Q

[jensequitur]

I took oral steroids for the worst flare I've ever had, and it brought everything down to a level where I could actually function.  I would have been better off with IV steroids, of course, but it was better than nothingn.

[Quixotic1]

You need massive doses of steroids to get any into the brain to try to calm the inflammation.  Oral steroids just aren't going to cut it.

An example.  A hefty dose of oral steroids is 80 mg or so of Prednisone and about 60mg of Medrol.  The dose used in MS is 1000mg of the Medrol equivalent and 1200mg of the prednisone equivalent.

It isn't just the overall dose that is important, but how fast you increase the level.  With oral administration the pills must dissolve and then be absorbed.  By definition the level does not go up very fast.  

With IV administration the level is instantaneously high.

It takes a day or so for the steroids to work.  And no, they should not make you worse, though I have noticed an increase in symptoms for the first day after an infusion and do not understand it.  Howver, steroids have their own st of side effects which can make you feel crummy.

Quix

[Lulu54]

I don't think the oral steroids would make you worse, they just are not effective at making you better, from what I know.  

I'm not really that fast, I'm just watching football and working on the laptop at the same time, wishing I had energy to get up and do something productive!  :-)

L

[Meaganj]

Thank you so much for responding so quickly! Do you know if oral steroids can actually worsen symptoms? Its my second day on them and I feel weaker and overall more achy and sick- u know that weird feeling of general ickyness that comes with a relapse, at least with my relapses. I will call my Doc today. Thank you thank thank you!!

[Lulu54]

No, oral steroids from what I know are going to be of little use to you.  They can't be given in high enough strength or concentration to be of significant use.  IV steroids is the way to go - can you call your doctor and tell them the oral version is doing nothing and ask for the IV instead?

feel better,
Lulu