Kirsty: There are differences in approach by medical staff to prescribe intravenous methylprednisolone, why is that?
Dr Belinda Weller, Neurologist: Well, there’s actually quite a lot of differences in the way steroids are prescribed, so methylprednisolone is just one variety of steroid. So, for example, you get methylprednisolone, you get prednisolone, you get dexamethasone and they’re all similar and they’ve got anti-inflammatory properties. Methylprednisolone is the one that we most commonly use to treat a relapse in multiple sclerosis and I think throughout the UK there are attempts to get a more standardised approach to treating the relapses, so the NICE guidelines, for example, have given guidance saying that 500 milligrams of methylprednisolone orally for five days is the preferred course. We don’t often bring people back in for IV because it’s been shown that the two are exactly the same in effectiveness and it’s easier if people don’t have to come in hospital. Occasionally though, if they have had trouble with the oral ones or they need to be in hospital for some other reason, you might give them IV. But generally it’s 500 milligrams of Methylprednisolone orally for five days.
Kirsty: What happens if somebody has a bad reaction to these steroids?
Dr Belinda Weller: I guess the main thing is to stop them straightaway. I mean the sorts of thing that can happen, so if somebody had an infection and they were treated with steroids it could potentially make that infection worse, so we usually test somebody’s urine and make sure they haven’t got any infection before we give them. The other thing I’ve seen is that people can go completely manic with steroids. At the least they might be unable to sleep or up cleaning the house at night, but I have had one or two people who’ve had to be detained to a psychiatric hospital because they’ve gone overly manic, so you do have to be a bit careful with them.
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