| Sumario: | Background: High‐dose methylprednisolone pulse therapy is being increasingly used in the treatment of neurological disorders; however, there is still a lack of studies on the side effects associated with this treatment regimen in the context of neurological diseases. Methods: We conducted a retrospective analysis of patients who received high‐dose methylprednisolone pulse therapy for neurological diseases at our hospital between January 2021 and August 2025. The clinical manifestations, auxiliary examinations, and outcomes were documented. We summarized and compared the clinical features of side effects associated with high‐dose methylprednisolone pulse therapy and investigated their risk factors. Results: A total of 42 pediatric patients were enrolled in this study. The most frequently observed adverse effect was decreased heart rate (41/42), among whom 14 cases developed sinus bradycardia. Additionally, 33 patients exhibited elevated WBC count. Concurrent presentation of decreased heart rate and elevated WBC count was observed in 31 patients, while coexisting sinus bradycardia and elevated WBC count were documented in 13 patients. We did not observe other commonly reported adverse effects such as hypertension and electrolyte disturbances. The side effects of methylprednisolone pulse therapy (increased WBC count and reduced heart rate) both showed a positive correlation with patient age. Conclusions: The occurrence of bradycardia and leukocytosis is observed in pediatric patients following methylprednisolone pulse therapy for neurological diseases during hospitalization. These phenomena, being asymptomatic and frequently going unnoticed, generally require no specific treatment and allow for the continuation of the therapeutic course with vigilant monitoring. However, it is important to note that five patients still exhibited sinus bradycardia at discharge, and long‐term outcomes were not assessed in this study. Therefore, our conclusions regarding the safety of continuing pulse therapy are based solely on short‐term in‐hospital observations. Ambulatory ECG monitoring is recommended prior to high‐dose methylprednisolone pulse therapy.
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