American Board of Family Medicine (ABFM) Practice Exam

What is the recommended treatment for acute flare-ups/exacerbations of multiple sclerosis (MS)?

1. Antidepressants

2. Antivirals

3. Corticosteroids

4. Nonsteroidal anti-inflammatory drugs

The correct answer is: Corticosteroids

The recommended treatment for acute flare-ups or exacerbations of multiple sclerosis (MS) is corticosteroids. This approach is based on their ability to reduce inflammation in the central nervous system, which is a key factor during MS exacerbations. Corticosteroids, such as methylprednisolone, are typically administered either intravenously or orally and can help to accelerate recovery from exacerbations by attenuating the immune response that contributes to the inflammatory process affecting the myelin sheath and nerve fibers. The use of corticosteroids is supported by clinical evidence indicating that they effectively improve neurological function during MS flare-ups and can reduce the severity of symptoms. This treatment is generally initiated as soon as possible after the onset of an exacerbation for optimal efficacy. In contrast to corticosteroids, other treatment options like antidepressants, antivirals, and nonsteroidal anti-inflammatory drugs (NSAIDs) do not address the underlying inflammatory activity characteristic of MS exacerbations. Antidepressants are primarily used for mood disorders and do not affect the pathological processes of MS. Antivirals may manage viral infections but are not indicated for controlling MS flare-ups. NSAIDs can provide symptomatic relief for associated pain but do not modify the inflammatory response during an exacerbation. Therefore, corticosteroids remain the