A 29-year-old woman with relapsing-remitting multiple sclerosis presents with an acute disabling relapse of right-sided pyramidal weakness. Visual acuity and bladder function are unaffected. What is the appropriate first-line treatment?

• A Oral prednisolone 60 mg daily for 2 weeks
• B Escalation of her disease-modifying therapy immediately
• C Plasma exchange as first-line therapy
• D Intravenous methylprednisolone 1 g daily for 3 to 5 days ✓

Explanation

Acute disabling MS relapses are treated with high-dose intravenous methylprednisolone 1 g daily for 3 to 5 days, which shortens recovery time but does not change long-term disability. Low-dose oral prednisolone is inadequate for acute relapses and was historically linked to rebound attacks. Plasma exchange is reserved for steroid-unresponsive severe attacks, particularly neuromyelitis optica spectrum episodes. Disease-modifying drugs reduce future relapse frequency and are not the treatment for the acute event itself.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.