What is the standard first-line treatment for an acute MS relapse?

• A. Methylprednisolone 1 g IV daily for 3–5 days.
• B. Oral prednisone 60 mg daily for 5 days.
• C. Intravenous immunoglobulin (IVIG).
• D. Plasmapheresis.

Answer: (A)

When an acute MS relapse occurs, the goal is to hasten recovery by dampening the inflammatory process around demyelinating lesions. The best-supported first-line approach is high-dose corticosteroids given as a pulse: intravenous methylprednisolone 1 gram daily for 3 to 5 days. This regimen reliably speeds up improvement of neurologic symptoms, though it doesn’t change the long-term course of the disease.

Oral prednisone can be used if IV therapy isn’t feasible, but the evidence for equivalence to IV methylprednisolone isn’t as strong, so IV remains the preferred first-line option. Intravenous immunoglobulin and plasmapheresis are typically reserved for relapse scenarios that don’t respond to steroids or when steroids are contraindicated, rather than as initial treatment.