anddiminishingthereleaseofproinflammatory cytokines. Numerous controlled, clinical trials have demonstrated that corticosteroid therapy hastens the recovery time from acute attacks, and that high-dose corticosteroids are significantly more effective than moderate- dosed regimens in achieving this goal. While high-dose corticosteroids have proven to shorten the duration of acute attacks, they have not demonstrated the ability to alter the progression of the disease. Neither do they necessarily improve the extent of recovery. (Recoveryfollowing a relapse maybe complete or incomplete, regardless of treatment.) Guidelines from the American Academy of Neurology recommend the following corticosteroid regimen – methylprednisolone 500-1000 mg/dayadministered intravenously for 3-5 days. Some physicians follow this regimenwith a 1-3week, oral prednisone taper. Patients usually improve within 3-5 days after start of the intravenously-administered, high-dose corticosteroid regimen. Some evidence suggests that equivalent doses of high-dose oral corticosteroids (i.e., prednisone or equivalent 600-1000 mg for 3-5 days) are comparable to intravenous-administered methylprednisolone; however, definitive studies of this route of administration are lacking. Despite their obvious benefits, adverse reactions associated with corticosteroids should not be underestimated. Short-term treatment with corticosteroids commonly produces a metallic taste in the mouth, insomnia, altered mood, headaches, body aches, and gastrointestinal pain. Fortunately, many of these adverse reactions can be decreased for mitigated with appropriate treatment strategies. The benefits of corticosteroid treatment must also be weighed against known risks (e.g., mood changes, elevations in blood pressure and serum glucose levels, and gastrointestinal adverse effects). Relative contraindications to corticosteroid treatment — or conditions that at least require close monitoring — include diabetes, hypertension, Strategies for Decreasing Adverse Reactions Associated with Corticosteroids • Metallic taste in mouth: Chocolate milk and/or candy may decrease this sensation • Insomnia: Short acting hypnotics or benzodiazepines may be useful; avoid using over-the-counter antihistamines (e.g., diphenhydramine) as they may worsen the metallic taste in the mouth • Gastrointestinal upset: Avoid all products that typically upset the stomach (e.g., spicy foods, caffeine) and minimize exposure to nonsteroidal-inflammatory drugs (e.g., naproxen sodium or ibuprofen); use over-the-counter histamine-2 blockers (e.g., ranitidine or famotidine) or antacids • Headaches/Body Aches: Use acetaminophen; avoid nonsteroidal-inflammatory drugs because they may worsen gastrointestinal upset 50 msfocusmagazine.org Medicine & Research