Medication Summary

The use of methylprednisolone, its indications, and its possible effects have been reviewed in Treatment. Other corticosteroids or intravenous gamma globulin (IVIG) possibly would also prove beneficial during the acute phase of presentation, but no information exists at present upon which to base any but the most general statements concerning these approaches. Whether intravenous corticosteroid therapy should be followed by an oral taper is unclear, although in most instances of recognized Schilderlike disease, such a taper is generally undertaken. No information exists concerning the appropriate length of such a taper or the influence of such a taper on outcome. No information exists concerning the efficacy of immunomodulatory therapy in Schilder disease as defined by the strict 1912-type criteria posed by CM Poser.

Patients who have received intravenous methylprednisolone should generally receive oral methylprednisolone for a period of 6 weeks, during which time they are tapered from an initial daily dose to every-other-day doses over 3 weeks and then the remaining alternate-day dose is tapered over the ensuing 3 weeks. The initial dose is 2 mg/kg/d or a maximum daily dose of 60-80 mg/kg/d. This taper may be prolonged as needed for patients who demonstrate recurrence of such symptoms and signs of illness as may have resolved during intravenous treatment. The enteral doses may be administered by nasogastric tube or other feeding tubes if the neurologic condition of the patient does not permit the doses to be swallowed. Coadministration of antacids or of histamine (H2) blockers is prudent during the entire course of corticosteroid therapy.

Patients must be monitored for such possible complications of corticosteroid therapy as hypertension, gastrointestinal hemorrhage, hypokalemia, hyperglycemia, and opportunistic infection.

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol)

View full drug information

The initial dose should be administered under close supervision because rare instances of anaphylaxis after initial dose have been reported.

Follow-up

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Author

Emad R Noor, MBChB Assistant Professor of Neurology and Clinical Neurophysiology, Hackensack Meridian School of Medicine; Attending Neurologist/Clinical Neurophysiologist, Neuroscience Institute at JFK Medical Center

Emad R Noor, MBChB is a member of the following medical societies: American Academy of Neurology, American Medical Association, Egyptian Society of Neurology, Psychiatry, and Neurosurgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

Robert Stanley Rust, Jr, MD, MA Former Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia School of Medicine; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust, Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, Society for Pediatric Research

Disclosure: Nothing to disclose.

William J Nowack, MD Associate Professor, Epilepsy Center, Department of Neurology, University of Kansas Medical Center

William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, Biomedical Engineering Society, American Clinical Neurophysiology Society, American Epilepsy Society, EEG and Clinical Neuroscience Society, American Medical Informatics Association

Disclosure: Nothing to disclose.