Do steroids help heal MS lesions?

Here is My Question:
For a relapse (new activity as seen by T2 hyperintensities on MRI), I know that IV steroids lessen the symptom load and duration. 

But I'm less clear on whether there are possible benefits from the steroids to the actual healing of the lesions themselves. I've heard yes and no. 

Can you help clear this up?

Answer:
Steroids shorten the duration of relapses and help speed up the recovery process. Prior studies failed to show a benefit on the degree of relapse recovery after 3 to 6 months. In other words if you wait long enough, the degree of clinical recovery is the same whether treated with steroids or untreated.

​However, many of the older studies are likely biased by the exclusion of people with more severe relapses. What I mean is that people with more severe relapses will tend to decline consent to enter a study so they can receive steroids without the risk of receiving a placebo or less active treatment. I suspect there are long term benefits of steroids in patients with severe relapses particularly if received within 2 weeks of onset. There is also evidence that MRI lesions responsible for relapses show less permanent long term damage in individuals treated with steroids.

This is why we tend to recommend steroids in people with moderate to severe relapses and often avoid steroids in people with mild, usually sensory relapses.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego