Editing Multiple sclerosis (section)

=== Initial management of acute flare ===
During symptomatic attacks, administration of high doses of [[intravenous therapy|intravenous]] [[corticosteroid]]s, such as [[methylprednisolone]], is the usual therapy,<ref name="pmid1897097722"/> with oral corticosteroids seeming to have a similar efficacy and safety profile.<ref>{{cite journal | vauthors = Burton JM, O'Connor PW, Hohol M, Beyene J | title = Oral versus intravenous steroids for treatment of relapses in multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | pages = CD006921 | date = December 2012 | pmid = 23235634 | doi = 10.1002/14651858.CD006921.pub3 }}</ref> Although effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.<ref>{{cite journal |vauthors=Filippini G, Brusaferri F, Sibley WA, et al. |title=Corticosteroids or ACTH for acute exacerbations in multiple sclerosis |journal=Cochrane Database Syst Rev |issue=4 |pages=CD001331 |year=2000 |volume=2013 |pmid=11034713 |doi=10.1002/14651858.CD001331 |pmc=11391333 }}</ref><ref name="RCOP_acute">{{cite book|author=The National Collaborating Centre for Chronic Conditions|title=Multiple sclerosis: national clinical guideline for diagnosis and management in primary and secondary care|year=2004|publisher=Royal College of Physicians|location=London|isbn=1-86016-182-0|chapter=Treatment of acute episodes|pages=54–58|url=https://www.ncbi.nlm.nih.gov/books/NBK48921/|pmid=21290636|access-date=5 October 2021|archive-date=10 February 2023|archive-url=https://web.archive.org/web/20230210212932/https://www.ncbi.nlm.nih.gov/books/NBK48921/|url-status=live}}</ref> The long-term benefit is unclear in optic neuritis as of 2020.<ref>{{cite journal |vauthors=Petzold A, Braithwaite T, van Oosten BW  |title=Case for a new corticosteroid treatment trial in optic neuritis: review of updated evidence |journal=J. Neurol. Neurosurg. Psychiatry |volume=91 |issue=1 |pages=9–14 |date=January 2020 |pmid=31740484 |pmc=6952848 |doi=10.1136/jnnp-2019-321653 |type= Review}}</ref><ref name="Petzold_2022" /> The consequences of severe attacks that do not respond to corticosteroids might be treatable by [[plasmapheresis]].<ref name="pmid1897097722"/>