Clinical study The effect of methylprednisolone treatment on cerebral reactivity in patients with multiple sclerosis Serhat O ¨ zkan * , Nevzat Uzuner, Ceyhan Kutlu, Demet O ¨ zbabalık, Gazi O ¨ zdemir Osmangazi University, Medical Faculty, Department of Neurology, Meselik Campus, 26480 Eskisehir, Turkey Received 22 November 2004; accepted 22 March 2005 Abstract We assessed the effect of intravenous high-dose methylprednisolone (IVMP) on cerebral reactivity in multiple sclerosis (MS) patients during exacerbations by means of functional transcranial Doppler imaging. Forty-eight clinically defined MS patients were evaluated with visual evoked potentials (VEP) and functional transcranial Doppler sonography (TCD) of both posterior cerebral arteries before and after 5 days of 1000 mg IVMP. After treatment, mean Expanded Disability Status Scale score, mean blood flow velocities and mean blood flow velocities at rest and at stimulation, significantly decreased (p < 0.0001, for each). The change in cerebral blood flow velocity ratio (CBFv) with visual stimulation after treatment increased slightly (p = 0.20). All TCD parameters were not significantly correlated with VEP changes. In conclusion, we observed significant changes in CBFv with a non-significant increase in vascular reactivity after treatment with IVMP in exacerbations of MS. Case-control studies are necessary to draw conclusions regarding the beneficial effects of IVMP treatment. Ó 2005 Elsevier Ltd. All rights reserved. Keywords: Multiple sclerosis; Cerebral reactivity; Transcranial Doppler; Methylprednisolone 1. Introduction There is a wide consensus that high-dose methylprednis- olone administered intravenously shortens the duration of acute multiple sclerosis (MS) exacerbations and it is the most commonly used treatment for MS exacerbation. 1,2 Although the efficacy of this treatment is clear, the mecha- nisms are still not well understood. Previous studies have suggested that they include inhibition of leukocyte dia- pedes through the blood-brain barrier; reduction of capil- lary permeability; decreased circulating T-helper cells and B-lymphocytes; and inhibition of proinflammatory cyto- kines causing a reduction in inflammatory edema in the brain parenchyma. 3–7 The acute clinical benefit of high- dose intravenous methlprednisolone (IVMP) is probably due to its effect on inflammation, rather than remyelination and repair of axonal injury. Although some investigation methods, including PET, SPECT and MRI techniques show parenchymal changes during MS exacerbations, they are expensive and difficult to repeat. 8–11 Transcranial Doppler sonography (TCD) is a non-invasive laboratory technique that can provide information about blood flow velocities in basal cerebral arteries. Continous recording of cerebral blood flow velocities in responsible arteries dur- ing functional tasks such as motor or visual stimulation can also provide information about the relationship between neuronal activation and vascular reactivity or ‘vasoneuro- nal coupling’. 12–14 In our recent study, we observed a more reactive posterior circulation to visual stimulation in MS patients during exacerbations than in controls, suggesting more reactive occipital cortical neurons. 15 This reactivity can be affected by changes in neuronal integrity, supportive parenchymal tissue and vascular structure, all of which participate in the inflammatory process of acute MS exacerbations. 0967-5868/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2005.03.023 * Corresponding author. Tel.: +90 222 2398080; fax: +90 222 2309696. E-mail address: scozkan@yahoo.com (S. O ¨ zkan). www.elsevier.com/locate/jocn Journal of Clinical Neuroscience 13 (2006) 214–217