Factors affecting response to relapse treatment in multiple sclerosis patients

Authors : Fatma Avşar Ertürk, Bülent Güven, Hayat Güven

Pages : 405-410

Doi:10.32322/jhsm.1608737

View : 61 | Download : 64

Publication Date : 2025-05-30

Article Type : Research Paper

Abstract :Aims: Relapses, a hallmark of multiple sclerosis, often lead to functional loss and a decline in quality of life. While the accelerating effect of intravenous methylprednisolone treatment on the recovery from multiple sclerosis relapses is well established, the rates of recovery can vary between relapses. This study aimed to evaluate the responses to intravenous methylprednisolone treatment administered during relapses in multiple sclerosis patients and to investigate the clinical factors and imaging characteristics influencing these responses. Methods: Patients diagnosed with relapsing-remitting multiple sclerosis who presented within the first 3 weeks of the onset of relapse symptoms were included in the study. Along with the patients’ demographic information, disease characteristics, Expanded Disability Status Scale scores during relapses, affected functional systems, and brain and spinal cord magnetic resonance imaging findings were recorded. As relapse treatment, patients were administered 1000 mg/day of intravenous methylprednisolone for 5 days. Expanded Disability Status Scale scores were calculated on the 5th, 15th, and 30th days of treatment. Patients were compared in terms of disease characteristics and imaging findings based on changes in Expanded Disability Status Scale scores before and after treatment on the 30th day. Results: A total of 50 relapsing-remitting multiple sclerosis patients (13 men and 37 women, mean age 32.5±9.2 years, mean disease duration 4.7±5.3 years) were included in the study. Improvements of varying degrees were observed in half of the patients by the 5th day of treatment and in all patients by the 15th and 30th days. The mean Expanded Disability Status Scale score of the patients before treatment was 3.2±1.0, which decreased to 1.4±0.9 on the 15th day and 0.4±0.6 on the 30th day after intravenous methylprednisolone treatment. In the group with greater improvement (≥3-point reduction in Expanded Disability Status Scale) on the 30th day compared to the group with less improvement (<3-point reduction in Expanded Disability Status Scale), the following were observed: higher pre-treatment Expanded Disability Status Scale scores (p<0.001), more frequent involvement of the pyramidal system during relapses (p<0.001), a higher number of patients with cerebellar demyelinating lesions on brain magnetic resonance imaging (p=0.01), and more frequent infratentorial lesion locations (p=0.04). Conclusion: Our findings demonstrated that symptom improvement on the 30th day of intravenous methylprednisolone treatment was greater than on the 15th day, suggesting that evaluating recovery from relapses before one month may be misleading. Furthermore, it was observed that improvement was more pronounced in relapses accompanied by pyramidal symptoms, which were more severe and disabling.
Keywords : Multipl skleroz, Atak, Metilprednizolon, Özürlülük

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