Corticosteroids are frequently utilized for the relief of progressive neurological symptoms. Initially they provide a marked improvement; however, this efficacy is generally transient. The dilemma often arises whether to further increase the dose of corticosteroids for symptom relief, which often results in a concomitant increase in the side effects of steroids, which are often burdensome in themselves. These adverse effects include hyperphagia, weight gain, body transformation, glucose intolerance, hypertension, mood disturbance, gastrointestinal bleeding and ulcers, and obstructive sleep apnea. Hyperphagia in itself can be of particular concern in those children with swallowing disturbances, as they are permanently hungry and are at risk of choking.