When Is Solu-Medrol Used in Multiple Sclerosis?

How Doctors Make the Decision to Use Solu-Medrol

Many of us with multiple sclerosis, especially relapsing-remitting MS (RRMS), have experienced a course of Solu-Medrol, the high-dose intravenous corticosteroid used to lessen the symptoms of relapses by decreasing inflammation in the central nervous system.

For many people, the effects of Solu-Medrol are just short of miraculous -– MS symptoms that were debilitating before the needle was even placed in the vein may be manageable or even gone by the time the first infusion is complete.

Certainly by two or three days into the course, the majority of people can report that those symptoms are much better.

However, losing the MS symptoms (and the panic that often accompanies them) allows people to shift their attention to the side effects of Solu-Medrol, which can be uncomfortable (to say the least), although not life-threatening.

For me, a Solu-Medrol treatment is like someone offering to remove a bear trap from my leg, while knowing that they are going to punch me in the face as soon as it is removed. Yes, the effects have been miraculous -- Bible-stuff miraculous – I was blind, then I could see; I could not walk, then I got up and marched out of the room. However, I was then a seeing, walking person who was experiencing anxiety, night sweats, insomnia, headaches and nausea. Sure, the trade-off is worth it in most cases, but I have wondered about how the decision is made by physicians to send patients on a Solu-Medrol “journey.”

Curious to learn more about how doctors decide when symptoms require Solu-Medrol and when to just take a “wait-and-see” approach, I checked out the article about treating multiple sclerosis relapses on UpToDate, an electronic reference used by many physicians and patients.

See what UpToDate has to say, then read on for answers to questions you may have about what all of this means for you.

When to Prescribe Solu-Medrol: Recommendations from UpToDate

“Indications for treatment of an acute exacerbation (relapse) in patients with MS include functionally disabling symptoms with objective evidence of neurologic impairment such as loss of vision, motor, and/or cerebellar symptoms. Mild sensory attacks are often not treated in the same manner, although symptomatic relief is sometimes necessary because of patient discomfort (e.g., due to paresthesia). Patients with relapsing-remitting MS who manifest current disease activity by either clinical symptoms or recent MRI lesions should be offered treatment with disease-modifying therapy, such as an interferon or glatiramer acetate.”

Your Questions: Answered

Fully understanding what this means not only give you a better sense of when you might expect to be prescribed Solu-Medrol, but it will help you be better able to discuss your situation with your doctor.

Am I Going to Be Prescribed Solu-Medrol?

If you are having a relapse, you probably will.
OK, you say, how do I know if I am having a relapse? While this is up to the doctor to determine definitively, you can suspect a relapse if you answer “yes” to the following questions:
  • Am I experiencing new symptoms or worsening of existing symptoms?
  • Has this worsening happened over the course of 24 hours to a couple of days?
  • Have these symptoms lasted more than 24 hours?
  • Has it been at least a month since my last relapse? (In other words, had these symptoms been non-existent or stable for at least 30 days before they appeared or got worse?)
  • Am I free of fever or infection?
For more information about relapses, read the full articles:

What If My Symptoms Are Getting Worse, But Gradually?

Nope, probably no Solu-Medrol coming your way. Solu-Medrol is typically reserved to treat relapses, rather than symptoms that are worsening slowly over time. These are the people mentioned in the above excerpt as “patients with relapsing-remitting MS who manifest current disease activity by…clinical symptoms” and the ones for whom disease-modifying therapy is recommended.

However, it could be that you have pain (paresthesia) or some other symptom that you have been dealing with for some time that just crossed a line of being intolerable. The doctor may be ready to try some Solu-Medrol in this case to bring you some relief, if he thinks it is a good idea. This decision will probably involve looking at the other available options for treating this symptom and how you have responded to these, combined with clues that he may glean from an MRI scan that this might help.

What If an MRI Shows Active Lesions, But I Don’t Have New Symptoms?

No Solu-Medrol for you. It turns out that many people with MS, especially relapsing-remitting multiple sclerosis in the early years, have little active lesions happening all the time. These are the lesions that “light up” in the presence of gadolinium (a contrast agent used for MRI scans) for about six weeks, then fade as the inflammation recedes.

I have seen a series of MRI scans of a person’s brain (separated by weeks) shown in rapid succession like a time-lapse movie. The result looks like fireworks -– lots of sparkly little lights all over the place as the lesions show up, fade, then appear somewhere else. However, very few of these are causing symptoms, and certainly not causing symptoms dramatic enough to apply the word “relapse” to the situation or to prescribe Solu-Medrol.

This is a situation of pretty normal RRMS activity and the recommendations are to have people on one of the disease-modifying therapies.

Bottom Line:

Symptoms have to be pretty bad to prescribe a course of Solu-Medrol, in most cases. However (and this is a big “HOWEVER”), there are many doctors out there who use Solu-Medrol differently from these recommendations.

Your doctor may see no problem with giving you a course at the least discomfort. You could be on “pulse treatment,” meaning that your doctor is trying to keep things under control by giving you a regular dose of Solu-Medrol at certain intervals (usually one to three months, but this approach also differs in frequency).

You could have a doc that thinks Solu-Medrol is not a good idea in any situation, in only the very most dire cases, or only for certain symptoms but not others.

Keep in mind, also, that if the potential side effects of Solu-Medtrol are scarier or more unpleasant to you than the symptoms the drug is aiming to treat, you can discuss this with your doctor. While there is clear evidence that Solu-Medrol helps lessen symptoms that you are having during a relapse, there is no evidence that there is long-term benefit. This means that if you can stand having the symptom (or trying to treat it some other way) and waiting out the relapse instead of taking Solu-Medrol, it does not mean that you are more likely to have permanent damage or residual effects from the relapse (than you would be if you did take the course of Solu-Medrol).

Related Articles:

Want to learn more? See UpToDate’s topic, "Treatment of acute exacerbations of multiple sclerosis in adults," for additional in-depth, current and unbiased medical information on multiple sclerosis in adults, including expert physician recommendations.


Michael J Olek, DO. Treatment of acute exacerbations of multiple sclerosis in adults. UpToDate. Accessed: February 2009.

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