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Neurology (Expert Forum)
Risks related to prednisone?
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Risks related to prednisone?
by Barbara-T, May 31, 1998 12:00AM
I had a viral illness last summer which left me with a scotoma in my left
eye. At the time an ON was suspected but so far I couldn't get a clear
diagnosis regarding my sight problems because I had no visus impairment or
altered VEP. I have an abnormal campimetry though, showing deficit in
temporal visual field and a pericentral scotoma.
Recently I found out there's another smaller scotoma close to the bigger one.
In January I started having gait problems and I had significant delayed latencies
in lower SSEP. A MRI was negative, as well as blood tests for other possible
causes (Lyme, vasculitis, HIV, LES, etc.)
The other day I had my third SSEP control done and latencies are still delayed
showing a worsening in CCT. My neuro gave me prednisone for two weeks.
Today I started taking it and I've had restlessness and pain in my legs and
lower back all day.
My question is: is prednisone a good choice? I've read of severe risk related
to steroids. I've never had pain before.
I was diagnosed with dorsal myelopathy but my neuro doesn't seem to exclude
a possible MS.
I want to follow his suggestions but I have doubts regarding prednisone.
Am I wrong??
Thanks for any suggestions!
Best regards,
Barbara
=
I think the first thing you should do is visit an MS specialist. At CCF, in the department of neurology, we have the Mellen Center, which has several MS experts on the staff. You are welcome to call 800 223-2273 and ask for neurology appointments, specify the Mellen Center.
If you have demonstrated optic neuritis but NO other lesion which can be identified as demyelinating in the CNS, then a diagnosis of MS can't yet be made. In the acute setting, high dose IV steroids seem to be a better choice than oral prednisone, though that finding has controversy and an MS expert can give you the most up-to-date advice. This far out from the initial event, the treatment rationale is completely different.
If you had a dorsal myelopathy (I'm not sure if you mean thoracic myelopathy - "dorsal" is an alternative term; or if you mean dorsal column myelopathy, involving ascending sensory tracts), as well as optic neuritis, then you may indeed have MS. Again, it is important to have this systematically checked by an experienced specialist.
Treatment of acute demyelinating episodes (within the first couple of weeks of onset) usually involves steroids, preferably given IV. For longer term treatment, the beta interferons have shown promise, but the specific pattern of illness must be identified and the treatment for one pattern of disease is not the same as the treatment for another.
I hope this helps. As you know, this information is provided for your medical education. Specific advice regarding diagnosis, prognosis, and treatment options must come from your doctor after appropriate evaluation. CCF MD mdf.
