Part One – Defining a MS Relapse

Relapse. Exacerbation. Attack. Flare-up. These are all terms for the same thing. What is a relapse and what can you do about it if you have one? The strict definition of a relapse is a new or worsened neurological symptom lasting at least 24 hours. There should be no better explanation for the symptoms. Relapses are one of the defining features of relapsing-remitting MS. They become less frequent with secondary-progressive MS and really should not be seen at all in primary-progressive MS. Sounds simple, right? Unfortunately, it’s not always so easy.

The very nature of MS is that even when people are in “remission” they still have symptoms. Things like fatigue, walking problems, bladder issues, pain and cognitive challenges may be present even when you are stable. Many of these baseline symptoms tend to wax and wane. In other words, many people with MS have good days and bad days. Sorting out these fluctuations from true relapses is not always straightforward. Things like stress, heat and sleep deprivation may all temporarily increase some symptoms.

Another challenge is the possibility of a pseudo-relapse. “Pseudo” does not mean that the symptoms are not real. It means that they are being driven by an underlying illness, most commonly an infection. Both urinary tract infections and even common colds will frequently result in an increase in things like weakness, numbness, visual changes, etc. For some people, the first symptom of an infection may be an increase in neurological issues. In addition, a pseudo exacerbation may also be triggered by the response of an MS patient to heat.

Relapses are important for many reasons. The unpredictable nature of MS attacks can lead to worry and anxiety. In my experience the first year after a new MS diagnosis can be the most challenging. The newly diagnosed person may struggle with the meaning of MS for life plans, new medications and the fear of the next attack. Every MS relapse is associated with a chance that there will be a new long-lasting symptom. One study showed that 50% of people experiencing a relapse still had residual new findings on neurological examination 3 months after the attack.

We’ll discuss treatment options in part two on Friday.

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