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Systemic Use of Corticosteroids in Neurological Disorders: Review Article
Systemic Use of Corticosteroids in Neurological Disorders: Review Article
Abstract
Corticosteroids have been used for almost 60 years in medicine and their roles in patients have
always been discussed by researchers and clinicians dedicated in the related field. Now they
are still used in treatment of patients with neurological disorders. Usually Corticosteroids are
used to decrease inflammations. In this review, we present five key indications, i.e., bacterial
meningitis, myasthenia gravis, Bell’s palsy and giant cell (temporal) arteritis for the systemic
use of corticosteroids in neurology based on a mix of prevalence, quality of evidence and
impact on disease management.
Results of clinical studies in humans are conflicting. The GIANT CELL (TEMPORAL) ARTERITIS
2002 European Dexamethasone Study evaluated the effect
of dexamethasone versus placebo in 301 patients with Diagnosis of giant cell arteritis (GCA) should be considered
bacterial meningitis. Mortality and neurological outcome in every elderly patient with new headache complaints,
were significantly better with corticosteroids at 8 weeks especially when there are associated manifestations as fever,
in patients with pneumococcal meningitis.[8] In contrast, weight loss, polymyalgia, jaw claudication, local tenderness/
studies in Malawi and Vietnam showed no benefit of welling and/or elevated sedimentation rate. The most
treatment with dexamethasone.[9,10] Recently, a Cochrane feared complication of GCA is visual loss due to anterior
meta-analysis examined over 4000 patients with bacterial ischemic optic neuropathy.
meningitis worldwide. Treatment with corticosteroids did
not change overall mortality, but survival was significantly Early treatment with oral corticosteroids (prednisone
better in patients with pneumococcal meningitis. 60 mg daily) is recommended, as soon as diagnosis is
Dexamethasone reduced rates of hearing loss and short- suspected. Practice is based on clinical experience, there
term neurological dysfunction in high-income countries, are no controlled trials. Patients often show dramatic
while this was not the case in low-income countries.[11] response to treatment. If associated visual loss is present,
Based on the available evidence, early administration IV methylprednisolone can be considered during the first
of dexamethasone 10 mg IV every 6 h for 4 days, or 3 days. As in MG, after several weeks of sustained clinical
until CSF cultures reveal a nonpneumococcal pathogen, remission, the dose can be gradually tapered but patients
is recommended for adults suspected with bacterial should be carefully monitored for possible relapses.
meningitis in developed regions.
REFERENCES
MYASTHENIA GRAVIS
1. Kobelt G, Berg J, Atherly D, Hadjimichael O. Costs and quality of
life in multiple sclerosis: A cross-sectional study in the United States.
Myasthenia gravis (MG) is pathology of neuromuscular Neurology 2006;66:1696-702.
transmission caused by an autoimmune response against 2. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG.
Multiple sclerosis. N Engl J Med 2000;343:938-52.
the postsynaptic membrane. Most patients have serum 3. Filippini G, Brusaferri F, Sibley WA, Citterio A, Ciucci G, Midgard R,
antibodies against the nicotinic acetylcholine receptor. et al. Corticosteroids or ACTH for acute exacerbations in multiple
Clinical features include skeletal muscle weakness and sclerosis. Cochrane Database Syst Rev 2000;4:CD001331.
4. Burton JM, O’Connor PW, Hohol M, Beyene J. Oral versus intravenous
fatigability. steroids for treatment of relapses in multiple sclerosis. Cochrane
Database Syst Rev 2012;12:CD006921.
More severe forms generally respond well to with high- 5. Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT,
Kaufman DI, et al. A randomized, controlled trial of corticosteroids in
dose oral prednisone (1 mg/kg daily). Evidence is based on the treatment of acute optic neuritis. The Optic Neuritis Study Group.
observational studies.[12,13] It is usually advised to start this N Engl J Med 1992;326:581-8.
6. Bhatt SM, Lauretano A, Cabellos C, Halpin C, Levine RA, Xu WZ,
regime in hospital-setting because some patients develop et al. Progression of hearing loss in experimental pneumococcal
a transient worsening of MG symptoms (after 5-10 days), meningitis: Correlation with cerebrospinal fluid cytochemistry. J Infect
which may lead to respiratory insufficiency. [13,14] An Dis 1993;167:675-83.
7. Sáez-Llorens X, Jafari HS, Severien C, Parras F, Olsen KD, Hansen EJ,
escalation regimen starting at a lower dose (e.g., 20 mg/day) et al. Enhanced attenuation of meningeal inflammation and brain
can avoid this risk in ambulatory patients.[15] edema by concomitant administration of anti-CD18 monoclonal
antibodies and dexamethasone in experimental Haemophilus 14. Miller RG, Milner-Brown HS, Mirka A. Prednisone-induced worsening
meningitis. J Clin Invest 1991;88:2003-11. of neuromuscular function in myasthenia gravis. Neurology
8. de Gans J, van de Beek D, European Dexamethasone in Adulthood 1986;36:729-32.
Bacterial Meningitis Study Investigators. Dexamethasone in adults 15. Seybold ME, Drachman DB. Gradually increasing doses of prednisone
with bacterial meningitis. N Engl J Med 2002;347:1549-56. in myasthenia gravis. Reducing the hazards of treatment. N Engl J
9. Scarborough M, Gordon SB, Whitty CJ, French N, Njalale Y, Chitani A, Med 1974;290:81-4.
et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan 16. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry
Africa. N Engl J Med 2007;357:2441-50. B, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy.
10. Nguyen TH, Tran TH, Thwaites G, Ly VC, Dinh XS, Ho Dang TN, et al. N Engl J Med 2007;357:1598-607.
Dexamethasone in Vietnamese adolescents and adults with bacterial 17. Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A,
meningitis. N Engl J Med 2007;357:2431-40. Hultcrantz M, et al. Prednisolone and valaciclovir in Bell’s palsy:
11. Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids A randomised, double-blind, placebo-controlled, multicentre trial.
for acute bacterial meningitis. Cochrane Database Syst Rev Lancet Neurol 2008;7:993-1000.
2013;6:CD004405.
12. Mann JD, Johns TR, Campa JF. Long-term administration of
corticosteroids in myasthenia gravis. Neurology 1976;26:729-40. How to cite this article: D’haeseleer M. Systemic use of corticosteroids
13. Pascuzzi RM, Coslett HB, Johns TR. Long-term corticosteroid in neurological disorders. J Transl Intern Med 2014;2:70-2.
treatment of myasthenia gravis: Report of 116 patients. Ann Neurol Source of Support: Nil, Conflict of Interest: None declared
1984;15:291-8.