Steroid therapy in neurological diseases and its side effects

1. Big picture

Corticosteroids are among the most important acute anti-inflammatory and anti-edema drugs in neurology. They are used when neurological damage is caused by:

• immune inflammation;
• demyelination;
• autoimmune vascular inflammation;
• vasogenic edema around tumors;
• nerve edema in selected cranial neuropathies;
• inflammatory muscle or nerve disease.

The key exam sentence:

Steroids are used in neurology mainly for MS relapse, myositis, myasthenia gravis with caution, CIDP but not acute GBS, vasogenic peritumoral edema, cerebral vasculitis, giant cell arteritis, Bell’s palsy, and selected meningitis/encephalitis contexts.

The most important exam trap:

Steroids are powerful, but not harmless: they may worsen infection, diabetes, psychosis, hypertension, gastric ulcer, osteoporosis and myasthenia if started abruptly at high dose.

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2. What corticosteroids do

Corticosteroids are anti-inflammatory and immunosuppressive drugs.

They:

• reduce cytokine production;
• decrease lymphocyte and macrophage activity;
• stabilize the blood-brain barrier;
• reduce vasogenic edema;
• suppress autoimmune inflammation;
• reduce capillary permeability;
• reduce inflammatory swelling around nerves, vessels, brain and spinal cord.

Common neurological steroids:

• methylprednisolone;
• prednisone / prednisolone;
• dexamethasone.

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3. Acute versus chronic steroid therapy