Can anyone lead me to an article about IVSM with no taper
 

I've not had that many episodes that I needed IVSM but I have always had a Prednisone taper. With this episode of ON I did not. So on this first day since the IVSM is over I just feel so blah, no energy. Coyuld some one lead me to an article of benefit of no taper VS taper

I have never had a taper. I too would like to see the research. I have always been unplugged and sent home. :cool:

I always had a taper, but I knew that some Docs were eliminating it, as unnecessary. I have no idea why or what made them come to that conclusion. Ask your Doc!:hug:

EDIT...I found this:
http://www.ncbi.nlm.nih.gov/pubmed/18459972

I have only had IVSM one time for five straight days. I hope to never have it again. I also did not do an oral taper. It seems that most neuros that are up to date with the research are not prescribing a taper anymore.

Thanks. I hope you never have to have it again also but it does work

I've had IVSM twice. Once without a taper (the first time) and once with a taper.

Having a taper made the crash from the steroids a heck of a lot easier to deal with. I got really sick the first time I had IVSM when the crash hit. (barfing sick)

I was still really tired and crashing a bit with the taper, but it was easier to deal with. Didnt get sick those first few days after I finished the IVSM. The second time I had IVSM, I pretty much begged for the taper.

Thanks Erin, that's how I feel. I am crashed

I never tapered it. 3 days, 1g a day was it.

Oral prednisone taper not desirable
 

Here is a good study that is ON-topic.

jackD


Eur J Neurol. 2008 Jul;15(7):677-80. Epub 2008 May 6.

Oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis.

Perumal JS, Caon C, Hreha S, Zabad R, Tselis A, Lisak R, Khan O.
SourceDepartment of Neurology, Multiple Sclerosis Clinical Research Center, Wayne State University School of Medicine, Detroit & The Detroit Medical Center, Detroit, MI 48201, USA.

Abstract
BACKGROUND: A short course of intravenous methylprednisolone (IVMP) followed by oral prednisone taper (OPT) is often used for the treatment of relapses in multiple sclerosis (MS). We examined the effect of IVMP plus OPT compared with IVMP only on neurologic disability 1 year after treatment of a relapse in patients with relapsing-remitting multiple sclerosis.

METHODS: Two hundred eighty-five consecutive relapses were analyzed in a retrospective fashion. One hundred fifty-two patients with a total of 171 relapses received IVMP plus an OPT at the time of relapse whilst 112 patients who experienced 114 relapses received IVMP without OPT.

RESULTS: There was no difference between the two groups in the baseline characteristics as well as the mean or categorical EDSS at baseline, at the time of relapse confirmation, and at months 3, 6 and 12 after relapse confirmation.

CONCLUSION: Our observations suggest that OPT following treatment with IVMP for an MS relapse does not lead to improved neurologic outcome after 12 months compared with treatment with IVMP only.

Moreover, our findings raise concerns regarding the common practice of using OPT following IVMP.

Further studies are indicated to validate our findings and minimize exposure to systemic corticosteroids, well known for systemic toxicity.

PMID: 18459972 [PubMed

oral prednisone alone for ON is VERY bad
 

I would like to add this additional information about steroid treatment for optic neuritis because it is very important.

Doing without the oral prednisone taper is desirable.

jackD


Semin Ophthalmol. 2002 Mar;17(1):4-10.

Treatment of acute demyelinating optic neuritis.

Balcer LJ, Galetta SL.
SourceDivision of Neuro-Ophthalmology, Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.

Abstract
Patients with typical acute monosymptomatic demyelinating optic neuritis should receive gadolinium-enhanced magnetic resonance imaging (MRI) of the brain and orbits to determine if they are at high risk for the subsequent development of clinically definite multiple sclerosis (CDMS). The presence of >or=2 white matter lesions (>or=3 mm in diameter, at least 1 lesion periventricular or ovoid) indicates high risk for CDMS; the following treatment should be considered for such patients: 1. Intravenous methylprednisolone sodium succinate (1 gram IV/day for 3 days) followed by oral prednisone (1 mg/kg/day for 11 days) with 4-day taper (20 mg on day 1, 10 mg on days 2 and 4); 2. Interferon beta 1-a (Avonex 30microg intramuscularly [IM] weekly, or Rebif 22 microg subcutaneously [SQ] weekly). These two drugs have been shown to reduce the short-term risk of CDMS in high risk monosymptomatic patients. In monosymptomatic patients with <2 white matter lesions, and in patients for whom CDMS has been established, IV methylprednisolone treatment followed by oral prednisone should be considered on an individual basis. Treatment in these patients may hasten visual recovery, but does not affect long-term visual outcome.

Oral prednisone alone, without prior treatment with IV methylprednisolone, may increase the risk for recurrent optic neuritis and should be avoided.

PMID: 15513449 [PubMed - indexed for MEDLINE]

IMO, the taper was to make the transition/withdrawal from the high dose IVSM, easier on our bodies, not to make the attack itself better.:confused:

Who knows, we're only lab rats anyway, to them!!:mad:

I agree Sally, the taper I had the 2nd time I had IVSM was to make coming off of the IVSM easier, and wasnt for the actual attack.

First time I had IVSM was for double vision. No taper with that. The crash afterwards was pretty nasty. I was sick (weak, really tired. Throwing up the first 2 or 3 days) for a couple of weeks after that.

Last year, I did IVSM because I had a flare that made me feel like I was having problems moving my right leg. I begged for the taper afterwards. I still felt tired and a little sick feeling on the taper, but I wasnt barfing sick from the crash like I was with the crash that I had after my first experience with IVSM. I felt like the taper helped the transition from having 3 grams of IVSM (1 gram a day for 3 days)

The taper made things easier and there was less barfing. (dont think I threw up while on the taper. Might have felt a bit queasy tho. Oral pred tastes nasty and does a number on the stomach)

i agree with Sally and Erin. I thought the reason for the taper was to help the adrenal gland recover and get back to producing it's own cortisol

My neurologist does 3.5 h infusions of IVSM, and a month-long taper. I had 6 infusions of IVSM when I had my first round of it.

My second relapse, I had 3 days of IVSM, 2.5 h infusion time, and no taper after. This was not my regular neurologist.

I asked the nurses at the day centre (where they do the infusions, city hospital). They just said that each neurologist has their own way of doing things and ordering the doses/number of days/time infusing & rate of infusion, etc.

I don't know if one's better than the other ... taper or no. I think that my neuro gave the taper of 1 month as it was at diagnosis and I had not had IVSM before, and 6 days was a huge shock to the system, and he wanted to be sure the inflammation was knocked down (I had a very active MRI initially, showing a very active disease process).

Then again, he's an old guy and pretty "By the books" about the meds. I find he 'overdoes' things - weekly to bi-weekly to monthly blood work on Copaxone... which isn't 'needed' as far as I know with C (with the interferons, yes).

ExAcTlY!!!!:cool: