Disclaimer: This is how we treat acute relapses at the Johns Hopkins Hospital. There are no worldwide or nationwide standard protocols, but there is a broad consensus on the general approach.
High dose steroids are almost always provided for treatment of an acute relapse. This type of steroid, methylprednisolone, is given once a day intravenously for 3-5 days. This medication is widely avaialble throughout the world and every local hospital.
The expectation is that steroids serve to suppress the inflammation associated with the relapse. They work right away. Depending on the severity of the relapse, there may be clinical improvement as soon as 24 hours after the first dose. More commonly, inflammation subsides slowly over the course of the treatment and recovery occurs over the next few weeks to months.
There are several side effects of high dose steriods, but most of them are short term. The most concerning is that steroids can cause psychosis or confusion. This side effect can be counteracted by other medications called anti-psychotics, but if this side effect occurs, it may be better to reduce the dose of steroids and switch to another treatment option .
Other side effects include high blood pressure, high blood sugar levels, change in mood -- usually elevates but can also cause irritability, increased urinary frequency, and abnormal lab values.
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