İlknur BAŞYİĞİT, Pervin İŞERİ, Hüsnü EFENDİ, Çiğdem ÖZERDEM, Hüseyin BAŞYİĞİT, Füsun YILDIZ

The effect of pulse methylprednisolone plus theophylline treatment on clinical, pulmonary and inflammatory markers in relapses of multiple sclerosis

Objective:The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmo - nary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor NecrosisFactor (TNF)-alpha levels and clinical scores in MS relapses.Study Design:Double blind randomized controlled trial. Material and Methods:The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysisof TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IVtheophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alphaon the 5 thand 30 thdays of the treatment.Results:Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, numberof exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFTfindings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was foundto be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5 thday 2.4±1.6; 30 thday 2±1.7). There was no statisticallysignificant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed inthe placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation betweenthe clinical parameters, PFT and TNF-alpha level.Conclusion:There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbationssince it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.

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