What is a relapse?
An MS relapse, also known as an exacerbation, attack, or flare, occurs when you develop new symptoms or experience a return or worsening of previous symptoms due to inflammation affecting your brain, spinal cord, or optic nerves. If you have relapsing-remitting MS (RRMS), relapses are a typical feature of the condition.
While relapses can occur in secondary progressive MS as well, they’re less frequent. Each relapse presents differently. You might experience a sudden onset of overwhelming fatigue, new episodes of numbness or tingling, or notice changes in your vision, coordination, or muscle strength.
What causes a relapse?
During a relapse, your immune system mistakenly targets the protective coating around your nerves, known as the myelin sheath. This attack triggers inflammation and damage that disrupts or blocks the messages your brain sends throughout your body.
You might notice new or worsening symptoms such as:
- numbness or tingling sensations
- weakness or muscle stiffness
- changes to your eyesight or temporary loss of vision
- overwhelming fatigue or dizziness
- difficulty with balance or walking smoothly
- trouble controlling your bladder or bowels
- challenges with clear thinking and memory.
How long will it last?
The length and severity of a relapse varies, some last just a few days while others continue for weeks or even months. Between relapses, you’ll typically experience remission periods when your symptoms get better or remain stable. For those with relapsing-remitting MS, these stable phases can extend for months or years before the next relapse occurs.
True relapse vs pseudo-relapse
When experiencing symptoms that are troubling, it is important to distinguish if what you are feeling is related to a true relapse, or a pseudo-relapse.
A true relapse occurs when new inflammation develops in your brain, spinal cord, or optic nerves. These episodes typically need treatment and won’t resolve on their own quickly.
A pseudo-relapse happens when symptoms you already have get worse temporarily. While the symptoms will feel real, in a pseudo-relapse; it is not caused by new nerve damage. Common triggers include:
- an infection like a UTI or cold
- exposure to heat or becoming overheated
- stress
- feelings of anxiety
- poor sleep
- physical overexertion.
Pseudo-relapses typically resolve within 24 to 48 hours, especially if the initial trigger is treated. This can mean starting antibiotics for an infection, cooling your temperature down, improving sleep quality, and managing stress and anxiety with strategies such as mindfulness. It’s important to remember that pseudo-relapses don’t cause new lesions or lasting damage, although it is still important to address the symptoms.
A few questions that can help you consider whether your symptoms are a true or pseudo-relapse, include:
- Have I experienced this symptom previously?
- Has it lasted less than 48 hours?
- Am I currently facing a known trigger (such as stress, infection, or sleep deprivation)?
If you answered yes to any of the above questions, you may be experiencing a pseudo-relapse. However, if your symptoms continue beyond a couple of days or seem new, don’t hesitate, contact your doctor.
When to Seek Help
If you are think you may be having a relapse, or are concerned about your symptoms, talk to your neurologist, GP or MS Nurse. If the symptoms have a sudden onset, you can try waiting 24-48 hours to see if they improve.
It will be useful to tell the health professional: when they symptoms started, what the symptoms are, if they are new or worsening, and how much they are affecting your daily life. It will also be helpful to discuss if there’s any factors you are experiencing that may cause symptoms to worsen such as stress, or an infection.
Your health professional will be able to assess whether you need medical treatment, and create a management plan. This may include steroids, an MRI, starting or switching the disease modifying drug you are on.
Impact on Disease Progression
While steroids aren’t disease-modifying and don’t provide long-term benefits, evidence suggests they shorten recovery time by more quickly resolving inflammatory mechanisms. Having relapses doesn’t necessarily mean disease-modifying therapy isn’t working, particularly within the first six months of starting treatment.
How to prevent relapses
In active RRMS, it is recommended starting a disease modifying therapy as early as possible to limit irreversible disease progression. Whilst no treatment is curative, one of the main aims of using a disease modifying therapy is to prevent future relapses from happening.
It is important to remember that having relapses doesn’t necessarily mean your treatment isn’t working. However, by the same token, if you have been on a DMT for a long enough time, there may be a discussion with your neurologist about switching medication.
Preventing and managing pseudo-relapses can include avoid overheating by exercising in air-conditioning, managing infections with antibiotics, and managing stress with mindfulness exercises.
Finally,it is important in your journey with MS to take steps to maintaining your brain health. https://www.msbrainhealth.org/people-with-ms/six-ways-to-lead-a-brain-healthy-lifestyle/
- Stay active
- Keep your weight under control
- Keep your mind active
- Avoid smoking
- Watch alcohol intake
- Consider other medications your doctor has prescribed.
