Corticosteroids and plasma exchange in multiple sclerosis.

Corticosteroids (CS) remain a mainstay of treatment for relapses in multiple sclerosis (MS) and optic neuritis. Currently, there is not enough evidence that long-term corticosteroid treatment delays progression of long-term disability in patients with MS. Likewise, it is unclear whether there are, in fact, true differences among the various CS agents, doses, and their applications in specific pulse and tapering regimens.In some patients suffering from severe steroid-resistant relapses, the clinical response to CS treatment may be insufficient. Such patients may obtain clinical benefit from subsequent plasma exchange (PE). PE is increasingly considered as an individual treatment decision in patients with severe relapses not properly responding to CS. Because of the lack of appropriate studies, PE is not recommended as a permanent disease-modifying strategy in MS patients.