Question Title: corticosteroid treatment for UC

1) By what mechanism does steroid use increase the potential for seizures?
2) How Does steroid use affect arteies and veins, and how does it predispose to Thromboembolism.? Any preventative measures that canbe taken?

It frustrates me that my doctor never answers these types of questions. Please answer in as technical terms as possible..I have an appropriate background. thank you for addressing this question.

Dear Laura,

I must begin by stating that oral corticosteroids are not indicated as maintenance therapy in the treatment of ulcerative colitis. It is time to get off of this medication.

Having said that, although convulsions or seizures are listed in the long list of side effects in the Physician's Desk Reference, they are certainly not very common. Most textbooks do not list this as a side effect. In order to try and answer your questions I finally went to a pharmacology textbook called Goodman & Gillman (the chapter on adrenocortical steroids). Corticosteroids seem to exert a number of indirect effects on the central nervous system, through maintenance of blood pressure, plasma glucose concentration and electrolyte concentrations. Improved awareness of the distribution and function of steroid receptors in the brain has led to increasing recognition of direct effects on the central nervous system, including effects on mood, behavior and brain excitability.

The most striking effect of corticosteroids on the cardiovascular system is hypertension. Hypertension is more pronounced with mineralocorticoids and their effect on renal sodium excretion. The mechanism of glucocorticoid associated hypertension is essentially unknown. On the other hand, it may be related to the endogenous secretion of cortisol.The resultant hypertension can lead to a diverse group of effects on the cardiovascular system including increased atherosclerosis, cerebral hemorrhage, stroke and hypertensive cardiomyopathy. Restricting dietary sodium intake can considerably lower blood pressure secondary to
corticosteroids. Adrenocortical steroids also have an effect on carbohydrate, protein and lipid metabolism which can accelerate atherosclerosis.

In my opinion, at the present time, the best way to prevent any complication from the steroids is to substitute other medicines so that you can be weaned off of the prednisone. A trial of aminosalicylates or immunosuppressive drugs may be needed. It is also important to keep in mind that ulcerative colitis can be cured with a total colectomy. I hope
you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.

HFHSM.D.-ym
*Keywords: ulcerative colitis, maintenance therapy, steroids