Understanding and Coping With MS Flares

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Tanuja Chitnis, MD, a Boston neurologist specializing in multiple sclerosis, likens the human nervous system to a massive jumble of electrical wires. Nerves transmit messages through this vast network all over your body. To protect them from “short circuits,” nerves are covered by what’s called a myelin sheath, an insulating layer of protein and fat.

In multiple sclerosis, an autoimmune disorder, your immune system mistakenly attacks your own nervous system, starting with the myelin sheath. Specific symptoms — vision loss, balance issues, fatigue, numbness and tingling — will then appear depending on where the damage occurs. In addition, without the myelin, electrical signals in your nervous system can be interrupted or slowed, causing MS symptoms to flare. It is a hallmark of multiple sclerosis that the symptoms caused by faulty nerve signals ebb and flow. An acute flare is often followed by a remission, which can last from months to even years before another episode occurs. Given the cyclical nature of the condition, the course of MS is anything but predictable.

Understanding an MS Flare
A multiple sclerosis flare is also called an exacerbation, a relapse, or an attack. A flare can involve either the appearance of new symptoms or the reappearance of older ones. Timing is also important: To be technically classified as a “relapse,” symptoms must last for 24 hours and must occur at least 30 days after your most recent flare-up. Dr. Chitnis, assistant professor of neurology and director of the Partners Pediatric MS Center at Massachusetts General Hospital for Children, compares the appearance of MS symptoms to those of a stroke, saying that “while a stroke comes on in a manner of minutes, MS symptoms [generally] come on over the course of several days.”

Symptoms of an MS Flare
MS symptoms generally vary from person to person. And this certainly holds true in the case of an MS flare. Severe fatigue is common, as are sensory problems, such as numbness and tingling in the arms and legs; vision problems, such as eye pain or blurred vision; weakness and balance difficulties; and bladder and bowel problems.

Causes of an MS Flare
While many things have been linked to multiple sclerosis flares, the exact cause of a flare can be difficult to pinpoint. “Flares can be triggered by infections, including [bladder infections],” says Chitnis. And “some evidence suggests that stress may trigger flares, but this is still controversial.” One misconception regarding what increases the risk of an MS flare: vaccines. “The evidence is strong that vaccinations do not trigger flares,” notes Chitnis.

Preventing an MS Flare
Though a multiple sclerosis flare cannot be prevented entirely, avoiding things that trigger attacks can help keep them at bay, at least in the short term. Since flares are sometimes triggered by infection, it’s especially important to wash your hands frequently during the cold and flu season and to talk about getting a flu shot with your doctor. Experts also recommend such simple tactics as drinking cranberry juice daily to help protect yourself from bladder infections.

Duration of an MS Flare 
Flares can last anywhere from a few days to a few weeks, depending on your response to treatment. Sometimes, a brief flare-up of symptoms can occur and then resolve without any treatment at all. This is called a pseudoexacerbation and is not technically classified as a relapse. These pseudoexacerbations are usually brought on by increased body temperature and go away when the body cools down, sometimes in a manner of minutes.

Treatment for an MS Flare
Flares can be treated with steroid medications that suppress the actions of the immune system, which helps to keep it from attacking the nervous system. This often slows the progression of a flare. But because the side effects of steroids can be serious, Chitnis says that doctors often weigh the long-term risks of steroid use against the immediate benefits of flare symptom relief.

Recovering from an MS Flare
Most people with MS are initially diagnosed with a form of the disease called relapsing-remitting MS. In this type of multiple sclerosis, when the attack on the myelin stops, symptoms gradually lessen. Some people will regain total functioning after flares, in others the recovery may only be partial. Rehabilitation can play an important role in regaining certain functions after flare-ups. A physical therapist, speech therapist, or occupational therapist can be useful additions to your team of health care providers to help you move forward with your life after a flare-up.