Management of Acute Relapses in Multiple Sclerosis

Acute relapses represent transient neurological dysfunction driven by focal inflammatory activity within the central nervous system. Rapid intervention aims to shorten symptom duration, expedite lesion resolution and minimise residual disability. High-dose corticosteroids—most commonly intravenous methylprednisolone administered over three to five days—remain the first-line therapy, producing full or partial recovery in the majority of patients. For individuals with inadequate response, escalation strategies such as plasmapheresis or immunoadsorption are employed to remove pathogenic antibodies and inflammatory mediators. Emerging alternatives, including repository corticotropin, offer supplementary immunomodulation, particularly in steroid-refractory cases. Integration of disease-modifying therapies both before and after relapses may attenuate severity and reduce frequency over time. Standardised follow-up visits enable early identification of non-responders, facilitating timely treatment adaptation. Current practice emphasises patient-centred outcomes, real-world evidence and personalised regimens to optimise safety, tolerability and long-term function.

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Management of Acute Relapses in Multiple Sclerosis publication trend

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Technical terms

Intravenous methylprednisolone: High-dose corticosteroid infusion used to accelerate remission of acute neurological symptoms in relapses.

Oral methylprednisolone: Corticosteroid taken by mouth at doses equivalent to intravenous treatment, offering a non-invasive alternative.

Plasmapheresis: A blood purification procedure that removes circulating antibodies and inflammatory mediators to treat severe or steroid-refractory relapses.

Immunoadsorption: A selective apheresis technique that targets and removes pathogenic immunoglobulins from plasma.

Disease-Modifying Therapies (DMTs): Medications aimed at reducing relapse frequency and delaying progression by modulating immune activity.

Repository corticotropin injection: An alternative relapse treatment stimulating endogenous steroid production and modulating immune responses.

Expanded Disability Status Scale (EDSS): A standardised scale for quantifying disability in multiple sclerosis, ranging from 0 (normal) to 10 (death attributable to MS).

References

1. Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials. PLOS ONE (2017).
2. A Prospective Observational Registry of Repository Corticotropin Injection (Acthar® Gel) for the Treatment of Multiple Sclerosis Relapse. Frontiers in Neurology (2020).
3. Saudi Consensus Recommendations on the Management of Multiple Sclerosis: Disease-Modifying Therapies and Management of Relapses. Clinical and Translational Neuroscience (2022).