Saturday, May 11, 2013

Q: 28 year old male is transferred from floor to ICU. Patient was admitted to floor 6 days ago with acute exacerbation of Multiple Sclerosis (MS). Patient did not show much improvement after high dose of steroid treatment. What could be your next step?

Answer:  Plasmapheresis

High doses of steroids (like 1000 mg of solumedrol) remained the mainstay of therapy for acute relapses in MS. Please note oral and IV corticosteroids have a similar efficacy.

Severe attacks of MS which do not respond to steroids are recommended to be treated by plasmapheresis.


1. Compston A, Coles A (October 2008). "Multiple sclerosis". Lancet 372 (9648): 1502–17.

2. Multiple sclerosis : national clinical guideline for diagnosis and management in primary and secondary care -  London: Royal College of Physicians. 2004. pp. 54–57.

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