Relapses, exacerbations, flares, attacks…they go by many names but they all mean the same thing- the immune system is actively attacking myelinated nerves in the brain and spinal cord. Even though it seems like it should be easy to tell if you are having a relapse or not, most people with RRMS have experienced something that makes them wonder “am I relapsing?” or “is this a MS symptom?”. When I was first diagnosed I think someone forgot to tell me that remission means something totally different then the image of remission that I had in my head. Even in remission we struggle with symptoms left behind by lesions from relapses. Furthermore, determining whether a symptom is a relapse, pseudo-exacerbation, or something else altogether can be difficult. I hope to clarify some things for you today!
The MS Society defines a relapse as any new or worsening symptom that lasts for more than 24 hours, happens more than 30 days after a previous attack, and that occurs in the absence of another cause such as stress, infection, or an elevation in body temperature.1
In addition to a relapse, external factors like stress, illness, or temperature changes can cause a sudden worsening of symptoms (or pseudo-exacerbation). This is why it’s important to avoid extreme temperatures, stress (when possible!), and aggressively treat fevers. However, anytime you have a new or worsening symptom that persists for 24 hours or more you should give your doctor a call and let them decide if it could be a relapse or not. For example, when symptoms of a relapse emerge many doctors will have you give a urine specimen to test for a urinary tract infection (UTI), because UTI’s can mimic symptoms of a relapse and are common in people with MS. It’s important to determine the cause of symptoms, because the treatment of an infection is very different than the treatment for a MS relapse.
To further evaluate new symptoms your doctor may order an MRI scan. During a relapse sometimes we are able to identify where in the central nervous system damage is occurring. This shows up as “enhancing lesions”, or lesions that light up brightly when contrast dye is given. These look different then old lesions, which do not react to dye. However, MRI images are not perfect and sometimes the pictures do not match the clinical exam (which is frustrating!). Therefore, you can’t conclusively rule out a relapse just because the MRI didn’t show any enhancing lesions. If your doctor determines that you are having a relapse, they will discuss options such as steroids or Acthar Gel.
Lets stop and clear up one very common misconception: there is no cure for relapses, only treatment. Steroids and Acthar Gel do not stop a relapse, or even minimize damage, but they do speed up recovery time. You will recover from a relapse to the same degree with or without medication. With medication the average recovery from a relapse is two weeks faster then without them. If a relapse is mild, meaning that symptoms are tolerable and don’t interfere with daily activities too much, then treatment may not be necessary. For mild relapses the side effects of the treatment may not outweigh the benefits of taking it, and that is a decision you and your provider can make together. Lets talk about the treatment options a little bit:
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