USE OF CORTICOSTEROIDS IN MULTIPLE-SCLEROSIS BY CONSULTANT NEUROLOGISTS IN THE UNITED-KINGDOM

Objectives - To survey the use of corticosteroids in multiple sclerosi s as recommended by United Kingdom consultant neurologists. Methods - A postal questionnaire covering the use of corticosteroids for acute m ultiple sclerosis relapse and chronic progressive multiple sclerosis w ith regard to frequency of use, type of corticosteroid, and dosage reg ime was sent to all members of the Association of British Neurologists with a United Kingdom address. Results - Two hundred and twelve Unite d Kingdom consultant neurologists replied to the survey (74% response rate). Eighty six per cent indicated that they prescribed corticostero ids in more than one quarter of acute multiple sclerosis relapses seen . Intravenous methylprednisolone was recommended at some time by 99% o f consultant neurologists, the most popular regime being Ig daily for 3 days (74%; 154/ 208). Over one half (53%; 109/206) never recommended a subsequent tapering course of oral corticosteroids; of those that d id, 25% (24/96) recommended a tapering course lasting more than 1 mont h. Eighty eight per cent (181/206) of prescribers of intravenous methy lprednisolone were able to offer the course as a day case on the ward; 7% (15/206) at an outpatient clinic; and 5% (11/206) at home. Almost three quarters of neurologists recommended oral corticosteroids for so me acute relapses, although the most popular response was for occasion al use only (48%; 101/212). Forty five per cent (96/211) at least occa sionally recommended steroids for patients with chronic multiple scler osis not experiencing an acute relapse. Conclusions - Although the vas t majority of consultant neurologists would prescribe intravenous meth ylprednisolone for acute multiple sclerosis relapse at some time, the use of corticosteroids for multiple sclerosis was otherwise variable. There seemed to be little consensus about the use of oral steroids in acute relapse, the prescribing of a tapering course of oral steroids a fter intravenous methylprednisolone, or the utility of steroids in chr onic multiple sclerosis. Variability of prescribing recommendations pr obably reflects a lack of clear evidence in the face of a wide range o f clinical situations, variable access, and timing of access to neurol ogists in the acute phase of relapse and pressure on neurologists to t reat in an otherwise ''hopeless'' situation. Large multicentred trials are needed to consider these issues.