Glucocorticoids are the first-line therapy of many neurological disorders, with the treatment regimen varying across types and characteristics of neurological disorders. This article reviews the national and international guidelines and expert consensuses in the past decade on glucocorticoids treatment for neurological disorders, and summarizes recommendations from the latest Chinese guidelines and consensuses. In summary, the most frequently used pulse therapy of glucocorticoids in China is intravenous infusion of high-dose (usually 1000 mg/d) methylprednisolone in a short period (often <5 d), followed by gradual tapering, bridging with oral prednisone or direct discontinuation. The treatment regimen for children and juveniles is similar to that for adults but the dose is adjusted by body weight. Pharmacodynamics of glucocorticoids should be considered for the treatment of perinatal women. To provide appropriate glucocorticoids treatment for patients with neurological disorders, clinicians should fully understand features of each neurological disorder and clinical characteristics of individual patient.
Citation: LIU Meng, WU Simiao. Guideline-recommended application of glucocorticoid in neurological disorders. West China Medical Journal, 2022, 37(12): 1891-1898. doi: 10.7507/1002-0179.202205015 Copy
Copyright ? the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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- 8. Buttgereit F, da Silva JAP, Boers M, et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis, 2002, 61(8): 718-722.
- 9. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol, 2016, 15(4): 391-404.
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- 11. Zuliani L, Nosadini M, Gastaldi M, et al. Management of antibody-mediated autoimmune encephalitis in adults and children: literature review and consensus-based practical recommendations. Neurol Sci, 2019, 40(10): 2017-2030.
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- 15. Filippini G, Brusaferri F, Sibley WA, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev, 2000(4): CD001331.
- 16. Yamout B, Sahraian M, Bohlega S, et al. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines. Mult Scler Relat Disord, 2020, 37: 101459.
- 17. Laplaud D, Bodiguel E, Bensa C, et al. Recommendations for the management of multiple sclerosis relapses. Rev Neurol (Paris), 2012, 168(5): 425-433.
- 18. Marques VD, Passos G, Mendes MF, et al. Brazilian consensus for the treatment of multiple sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis. Arq Neuropsiquiatr, 2018, 76(8): 539-554.
- 19. Shatila AR, Koussa S, Jabbour R, et al. LSN MS guidelines for the management of multiple sclerosis. Rev Neurol (Paris), 2013, 169(12): 950-955.
- 20. Huppke P, G?rtner J. A practical guide to pediatric multiple sclerosis. Neuropediatrics, 2010, 41(4): 157-162.
- 21. Ghezzi A, Banwell B, Boyko A, et al. The management of multiple sclerosis in children: a European view. Mult Scler, 2010, 16(10): 1258-1267.
- 22. Waldman AT, Gorman MP, Rensel MR, et al. Management of pediatric central nervous system demyelinating disorders: consensus of United States neurologists. J Child Neurol, 2011, 26(6): 675-682.
- 23. Liguori NF, Alonso R, Pinheiro AA, et al. Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina. Mult Scler Relat Disord, 2020, 43: 102147.
- 24. Dobson R, Dassan P, Roberts M, et al. UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines. Pract Neurol, 2019, 19(2): 106-114.
- 25. 中國免疫學會神經免疫分會. 中國視神經脊髓炎譜系疾病診斷與治療指南(2021 版). 中國神經免疫學和神經病學雜志, 2021, 28(6): 423-436.
- 26. Carnero Contentti E, Rojas JI, Cristiano E, et al. Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice. Mult Scler Relat Disord, 2020, 45: 102428.
- 27. Sellner J, Boggild M, Clanet M, et al. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol, 2010, 17(8): 1019-1032.
- 28. Sahraian MA, Moghadasi AN, Azimi AR, et al. Diagnosis and management of neuromyelitis optica spectrum disorder (NMOSD) in Iran: a consensus guideline and recommendations. Mult Scler Relat Disord, 2017, 18: 144-151.
- 29. Trebst C, Jarius S, Berthele A, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol, 2014, 261(1): 1-16.
- 30. Yamasaki R, Matsushita T, Fukazawa T, et al. Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica. Mult Scler, 2016, 22(10): 1337-1348.
- 31. 中國免疫學會神經免疫分會. 抗髓鞘少突膠質細胞糖蛋白免疫球蛋白 G 抗體相關疾病診斷和治療中國專家共識. 中國神經免疫學和神經病學雜志, 2020, 27(2): 86-95.
- 32. Bruijstens AL, Wendel EM, Lechner C, et al. E. U. paediatric MOG consortium consensus: Part 5 - Treatment of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders . Eur J Paediatr Neurol, 2020, 29: 41-53.
- 33. 賈建平, 陳生弟. 神經病學. 北京: 人民衛生出版社, 2015: 324.
- 34. Scott TF, Frohman EM, De Seze J, et al. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2011, 77(24): 2128-2134.
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