Purpose: To evaluate the efficacy of pulse therapy and endolumbar (intrathecal) administration of glucocorticoids in patients with spinal forms of multiple sclerosis across different disease courses.

A total of 108 patients were examined, including 66 (33 with a relapsing course (RC) and 33 with progressive types of course (PTC)) who received glucocorticoid pulse therapy (GCT), and 42 patients (12 with RC and 30 with PTC) who received endolumbar administration of GCT. Age: RC — (42.3 ± 3.2) years; PTC — (50.2 ± 3.1) years; mean age at disease onset: RC — (27.9 ± 2.9) years, PTC — (32.9 ± 3.6) years; disease duration: RC — (14.1 ± 2.6) years, PTC — (17.3 ± 2.8) years.

Clinical-mathematical analysis methods: questionnaires, clinical neurological assessment, standard confidence intervals; the Wilcoxon signed-rank test for paired (pre/post) ordinal data; and McNemar’s test for binary (0/1) dichotomous variables

In RC, treatment with glucocorticoid pulse therapy promoted regression of lower-limb spastic paraparesis, marked improvement in gait, increased ability to cover longer distances, and enhanced physical activity. Endolumbar administration of GCT had positive but differentiated, patient-specific effects on the pattern of lower-limb paraparesis and tone abnormalities, and also improved gait and unassisted ambulation. At the same time, normalization of sensory disturbances, sphincter control, disappearance of pathological plantar signs, and restoration of abdominal reflexes did not reach statistical significance. In patients with PTC, under both administration regimens, the positive dynamics of neurological status involved only a slight, partial regression of neurological deficit and were selective in nature, with insufficient recovery of physical activity, especially in severe cases.

The study demonstrated that the effectiveness of pathogenetic therapy with GCT depends on the administration regimen (pulse therapy vs. endolumbar administration), disease course type, and the severity of neurological deficit. In RC, a full regression of clinical symptoms redominated regardless of regimen. In PTC — particularly in severe patients after an endolumbar course — recovery of motor, tone, and sensory disturbances was partial and selective.