Safety of Intrathecal Steroids in Multiple Sclerosis

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To the Editor. —Nelson's review1 leaves many aspects uncovered and omits pertinent data that have been helpful for advocates who believe that intrathecal methylprednisolone acetate (Depo-Medrol) does have a safe role in the symptomatic management of lower limb spasticity in multiple sclerosis. I shall not address claims of effective epidural therapy in patients with radiculopathy. The article fails to mention previous discussions in similar forum2,3 and data from our own studies4 in which 100 patients with multiple sclerosis, with severe spastic paraparesis not responsive to common pharmacologic agents, were given 285 intrathecal injections of 80 mg of methylprednisolone acetate given each at 3- to 6- month intervals, with an average of 3.02 injections per patient per 24 months. By adhering to simple criteria for indications (spasticity, incapacitating clonus, gait, and sphincter dysfunction)

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