Understanding Steroid Injections for MS
Steroid injections, most commonly in the form of intravenous (IV) methylprednisolone, are used to treat acute and severe multiple sclerosis (MS) relapses. These powerful anti-inflammatory drugs do not cure MS or prevent future relapses, but they can help shorten the duration and reduce the severity of a current flare-up by reducing the inflammation that damages nerve fibers. Because they are typically reserved for severe relapses that significantly interfere with a person's ability to function, such as those causing severe weakness or vision problems, the benefits often outweigh the short-term side effects. However, understanding the potential adverse effects is crucial for informed decision-making and proper management.
How Steroids Work in Multiple Sclerosis
During an MS relapse, the immune system launches an attack on the myelin sheath, the protective covering of nerve fibers, in the central nervous system. Steroid injections act by powerfully suppressing this immune response and reducing the resulting inflammation. This helps to minimize nerve damage and allows for a quicker recovery from the acute symptoms of the relapse. The treatment usually involves a high-dose IV infusion over several days, sometimes followed by an oral steroid taper.
Common Short-Term Side Effects
The short-term side effects of high-dose steroid treatment are common, but they typically resolve once the treatment course is complete. Patients should be prepared for these potential temporary changes:
- Metallic Taste: A distinctive metallic taste in the mouth is a very common side effect, especially during IV infusions. Sucking on hard candies or mints can help alleviate this.
- Mood and Behavioral Changes: Steroids can cause a wide spectrum of mood changes, from mild irritability and restlessness to more intense feelings of euphoria, anxiety, or depression. Informing loved ones can help them provide support and understand that the behavior is medication-induced.
- Insomnia: A temporary surge of energy is common with high-dose steroids, leading to difficulty sleeping or staying asleep. Scheduling infusions or taking oral doses in the morning can help minimize this effect.
- Gastrointestinal Issues: Stomach irritation, indigestion, heartburn, and an upset stomach are frequently reported. Taking steroids with food can help, and a doctor may prescribe an antacid or proton pump inhibitor.
- Fluid Retention and Weight Gain: Steroids can cause the body to retain fluid, leading to bloating and swelling in the hands, ankles, and feet. This typically resolves within days of completing the treatment.
- Increased Appetite: Many people experience a noticeable increase in appetite while on steroids, which can lead to weight gain.
- Increased Blood Sugar: Steroids can elevate blood glucose levels, a significant concern for individuals with pre-existing diabetes. Close monitoring is necessary, and insulin or other diabetes medications may need to be adjusted.
- Facial Flushing: A reddening or flushing of the face is a known side effect.
- Headaches: Headaches are another frequently reported temporary side effect.
Potential Long-Term Side Effects
While high-dose steroid courses for MS are typically short-term, repeated or prolonged use can increase the risk of more serious, long-lasting complications. This is why healthcare providers generally limit the number of steroid courses a person can receive in a year. Potential long-term side effects include:
- Osteoporosis: Long-term corticosteroid use can lead to bone thinning, increasing the risk of fractures. A doctor may recommend calcium and vitamin D supplements or bone density scans.
- Cataracts and Glaucoma: The risk of developing eye problems like cataracts and glaucoma increases with long-term steroid use.
- Avascular Necrosis: In rare cases, long-term steroid use can cause the deterioration of bone tissue, most commonly in the hip, a condition known as avascular necrosis.
- Diabetes: Prolonged treatment can trigger or worsen diabetes by causing persistent high blood sugar.
- Immunosuppression: Steroids suppress the immune system, making a person more vulnerable to infections. For this reason, a doctor will always check for infection before starting a steroid course for an MS relapse.
Steroid Injections vs. Oral Steroids: Side Effects Comparison
| Side Effect | Intravenous (IV) Steroids | Oral Steroids (High-Dose) | Oral Steroids (Long-Term/Low-Dose) |
|---|---|---|---|
| Route of Administration | Direct infusion into a vein. | Taken by mouth in pill form. | Taken by mouth for extended periods. |
| Common Short-Term Side Effects | Metallic taste, insomnia, mood changes, facial flushing, increased appetite, GI upset. | Similar to IV steroids: insomnia, mood swings, increased appetite, fluid retention. | Increased appetite, weight gain, swelling. |
| Long-Term Side Effects | Risk of osteoporosis, cataracts, and avascular necrosis with repeated courses. | Risk of osteoporosis, cataracts, and avascular necrosis with repeated courses. | Higher risk of osteoporosis, cataracts, glaucoma, high blood sugar, thinning skin. |
| Stomach Protection | Often not needed for short course, but a doctor may recommend an antacid for GI issues. | Taking pills with food is recommended; an antacid may be prescribed. | Antacids or other protective medicines are commonly prescribed. |
| Management of Side Effects | Same-day infusion allows for immediate medical attention if needed. | Can be managed at home, but require close communication with a doctor. | Requires long-term management and regular medical check-ups. |
When to Contact Your Doctor
While many steroid side effects are manageable, some symptoms warrant immediate medical attention. Call your healthcare provider immediately if you experience any of the following during or after a steroid injection course:
- Signs of infection, such as a fever, sore throat, or chills.
- Significant swelling in the face, tongue, or legs.
- Vision problems.
- Extreme changes in mood or personality, such as severe depression or euphoria.
- Confusion or seizures.
- Difficulty breathing or swallowing.
Conclusion
Steroid injections are an effective tool for managing severe MS relapses, offering a way to shorten the duration and intensity of a flare-up. However, they are not without potential side effects, which can range from minor and temporary issues like insomnia and a metallic taste to more serious long-term complications with repeated use. Proper communication with your healthcare provider about your symptoms and medical history is essential for determining if steroid treatment is appropriate and for creating a plan to manage any potential side effects. The key is to weigh the benefits of a quicker recovery from a debilitating relapse against the risks of these adverse effects, always prioritizing your overall health.
For more in-depth information about MS treatment, including specific details on methylprednisolone, visit the MS Trust.
