What is causing my vertigo?

Here is my question:
I was diagnosed in 1996 with RR and based on recent MRIs have little to no increases in lesions but for last 2 years been suffering with constant vertigo episodes and my neuro has been giving me low dose IV steroid treatments. I was on Avonex for 12 years beginning in 1996 before my physician Dr. Phillips recommended me to stop and in 2006 recommended that I remove myself from stress by retiring. All of which I did and was fine until May 2013. That is when the constant vertigo began. So now I am seeing a new doctor who doesn't seem to think I should go on any other type drug program but is treating me with steroids monthly 3 months at a time. However I have been told many times that these steroid treatments are done all at once (like for 3 straight days) so I'm not sure where I go from here. I'm thinking about changing doctors. What is your suggestion?

Answer:
It seems like you have two unrelated questions; what is causing your vertigo and what is an appropriate dosing frequency for IV steroids? First, dizziness and vertigo are very common symptoms even in the absence of MS. It is important to determine the cause so that the most appropriate treatment is applied. There are doctors who specialize in this problem who are called neuro-otologists and seeing one of them would be a good first step. You mention Dr Phillips in your message. If you live in the Dallas area, Elliott Frohman would be a great person to sort out the cause of your dizziness since he is an MS specialist trained in this type of problem.

Second, there are many different IV steroid dosing regimens. How they all got started is story unto itself. One regimen I have never understood is the single dose infusion given once every month. There is no evidence that this regimen in any dose is beneficial. In fact this dosing regimen was initially used as a convenience control group in studies to demonstrate that other monthly therapies like monthly IV cyclophosphamide or monthly IV steroids for 3 to 5 consecutive days were beneficial. In other words patients were blindly treated (i.e. didn't know what they were getting) with a single monthly dose of cyclophosphamide or a monthly single dose of IV methlprednisolone (steroids) and cyclophosphamide was better. We never intended for doctors to treat patients with the control regimen (the single monthly dose of IV steroids) but they do it anyway out of convenience. Similarly, multiple consecutive doses of IV steroids for 3-5 days have been compared to a single dose many years ago and found to be more effective at treating relapses. So I do not advocate the use of monthly single dose infusions of steroids.

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