MS – Steroid-Refractory Relapse — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Steroid-Refractory RelapseSCE Neurology

A 28-year-old woman with RRMS on no DMT presents with an acute relapse of right optic neuritis. She receives IV methylprednisolone for 5 days with partial improvement. After 2 weeks, her visual acuity remains 6/36 with a dense central scotoma. What should be considered as escalation treatment?

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Correct answer: E — Plasma exchange

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

For steroid-refractory MS relapses (incomplete recovery after adequate IV methylprednisolone), plasma exchange (PLEX) is the recommended escalation therapy. Evidence from randomised trials supports PLEX for severe, steroid-refractory relapses, particularly optic neuritis and myelitis. A: A second course of methylprednisolone may be tried but PLEX is the recommended escalation. C: Azathioprine is a chronic immunosuppressant, not relapse treatment. D/E: These are not standard relapse treatments.

Reference: ABN MS Guidelines (2022); NICE NG100 MS (2022)