American Board of Psychiatry and Neurology (ABPN) Practice Exam

The treatment of choice for an acute exacerbation of multiple sclerosis (MS) is intravenous corticosteroid therapy. This approach is supported by extensive clinical experience and data, demonstrating its effectiveness in reducing inflammation and accelerating recovery during exacerbations.

When patients experience an acute relapse, corticosteroids such as methylprednisolone are administered intravenously over a short period, typically 3 to 5 days. The mechanism of action involves decreasing the immune response, thereby lessening the severity and duration of symptoms associated with the exacerbation. Corticosteroids help to stabilize the blood-brain barrier, reduce edema, and contribute to the resolution of the inflammatory process that characterizes MS attacks.

While other options exist for different treatment scenarios—such as plasmapheresis, which is generally reserved for severe cases that do not respond to corticosteroids, and intravenous immunoglobulin therapy, which may be used in specific contexts or types of inflammatory neuropathies—none of them are considered first-line for acute MS exacerbations. Sublingual aspirin and intravenous heparin are not relevant for treating MS exacerbations and are instead utilized for conditions involving cardiovascular risks or complications. Thus, intravenous corticosteroid therapy stands out as the primary and most effective treatment for acute exacerbations of multiple