S. Antonio Abate Hospital, Gallarate, Italy.
Neurol Sci. 2013 Feb;34(2):197-203. doi: 10.1007/s10072-012-0981-5. Epub 2012 Mar 11.
Despite the existence of therapeutic guidelines, management of multiple sclerosis relapse remains heterogeneous. Optimisation of relapse outcome demands an improved understanding of the neurologist's therapeutic attitude towards relapse management, which is the aim of this study. Neurologists from 13 multiple sclerosis centres completed a questionnaire every time they assessed multiple sclerosis relapses. The questionnaire requested a guided description of the relapse's clinical characteristics and an indication of the prescribed therapy, supported with up to 3 out of 20 suggested reasons. Over 3 months, 368 questionnaires were collected. Median percentage (%) of 21 relapses resulting in a prescription was 88.9%. Corticosteroids represented the most frequent prescription. A short-course of high-dose intravenous methylprednisolone was the most used corticosteroid (73.7%). Treatment was administrated mainly in day case unit (80.0%) and at home (13.6%). A tapered therapy was prescribed to 28.8% of patients. Neurologists' therapeutic decisions were driven mainly by relapse severity (45.3%) and symptom evolution (24.2%). Our study confirms the therapeutic attitude of multiple sclerosis specialists in treating relapses with high-dose intravenous corticosteroids in a day hospital setting, with a tapering in a proportion of cases. The main reasons for prescription are relapse severity and symptom evolution.
尽管存在治疗指南，但多发性硬化症复发的治疗仍然存在异质性。为了优化复发结果，需要更好地了解神经科医生对复发管理的治疗态度，这是本研究的目的。13 个多发性硬化症中心的神经科医生每次评估多发性硬化症复发时都会填写一份问卷。问卷要求对复发的临床特征进行有指导的描述，并指出所开的治疗方法，并提供最多 20 个建议原因中的 3 个。在 3 个月内，共收集了 368 份问卷。21 次导致处方的复发中位数（%）为 88.9%。皮质类固醇是最常见的处方。短疗程大剂量静脉注射甲基强的松龙是最常用的皮质类固醇（73.7%）。治疗主要在日间病房（80.0%）和家中（13.6%）进行。28.8%的患者接受了逐渐减少剂量的治疗。神经科医生的治疗决策主要受复发严重程度（45.3%）和症状演变（24.2%）的驱动。我们的研究证实了多发性硬化症专家在治疗复发时的治疗态度，即在日间医院环境中使用大剂量静脉内皮质类固醇，并在一定比例的病例中逐渐减少剂量。处方的主要原因是复发的严重程度和症状的演变。
