Know the signs of an MS relapse and how to handle it.
When a patient is diagnosed with relapsing-remitting MS, their antennae are automatically up for signs and symptoms of a relapse, which is a short-term flare that involves new symptoms in a specific spot on the body. The symptom usually comes on over the course of days to weeks and then goes away over days to weeks.
There are a lot of misconceptions around MS relapses and how to handle them. Here, neurologist Michelle Fabian, MD, clears things up.
What Are Symptoms of an MS Relapse?
“There are some very typical relapse symptoms of MS,” says Dr. Fabian. Those include optic neuritis (a temporary visual blurring), dizziness, numbness, or weakness. “It’s a localized thing. Either it would be one half of the body or maybe both legs, but something that’s localized on the body.”
What Causes an MS Relapse?
The truth is, doctors don’t know. “We don’t really understand why a patient has the onset of a relapse but for some reason the immune system turns on and the white blood cells go into the central nervous system and create a new lesion in the brain or the spinal cord,” explains Dr. Fabian. She says there are two things known to make relapses more likely:
1. Infection, like a flu: “If a person has an infection with relapsing remitting MS, most of the time they don’t develop a relapse, but sometimes they can,” says Dr. Fabian. What happens is the the immune system gets activated to fight the infection and then continues to attack the central nervous system.
2. Being postpartum: For some women after they have a child, they have an increased risk of having an MS relapse.
How Are MS Relapses Treated?
This might be surprising, but not all MS relapses require treatment. The regular immune-modifying medication patients take helps prevent relapses from happening in the first place. But should a relapse occur, treatment may only be necessary if symptoms are taking a toll on your safety or quality of life.
“We have them come in, we examine them and we monitor the symptoms. The reason we treat a relapse is if a person has trouble functioning. That would typically mean seeing, walking or using their hands or they’re in pain, which is rare and then we would use steroids,” says Dr. Fabian. These drugs don’t prevent relapses from happening, but they can help decrease the time the patient has a relapse.
What Should a Patient Do During a Relapse?
First things first, always call your doctor. “I like to worry about it with you,” says Dr. Fabian. “I don’t want you to just be at home worrying about that symptom by yourself.” Second, it’s important to know that, with newer MS medication options, relapses actually happen much less frequently; it can be years between them. So a relapse could be a sign that your current MS treatment isn’t working as well as it should be. And your doctor might want to consider changing your treatment plan.
Second, take things easier. Try to avoid activities that will make you feel worse. You might need to take public transportation or drive to work instead of walking, for example. And carve out time for plenty of rest, so you “give your body a break until you can get better,” says Dr. Fabian.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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Relapsing-remitting MS is a form of MS
where a patient only has episodes of
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inflammation or relapses, and
they don't have any signs of progression.
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What that means is they'll have a new
symptom that comes on over days and
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then usually leaves over days and weeks.
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And when they're not having a relapse,
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they're not getting any worse
in terms of their symptoms.
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The first day people don't usually
know they\re having a relapse,
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because it could just be kind of an off
day, a symptom that's gonna go away.
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But if the symptom is more the next day,
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then especially if it's more the next day.
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That's when I think people really
know that they're in a relapse.
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So there are some very typical
relapse symptoms of MS, and
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those would be optic neuritis.
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So that would be a temporary
visual blurring, dizziness,
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numbness, or weakness and
that's like a localized thing.
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Like either it will be one half of
the body or maybe both legs, but
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something that's localized on the body.
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It's not usually the entire body.
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And we don't really understand why
a patient has the onset of a relapse,
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some reason the immune system turns on.
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And the white blood cells go into
the central nervous system, and
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create a new lesion in the brain or
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There's only two things that we know
that can trigger an MS relapse.
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One thing is an infection.
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So if a person has an infection
with relapsing-remitting MS,
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most of the time they don't develop
a relapse, but sometimes they can.
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We do know that what happens is
the immune system gets activated to fight
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And then they attack on
the central nervous system.
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The second thing is that some
women after they have a child,
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they do have an increased
risk of having a relapse.
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So, not all relapses are treated.
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It depends on what the relapse is.
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So if a patient is
tolerating the symptoms,
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we actually just have them come in, we
examine them and we monitor the symptoms.
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The reason we treat a relapse is if
a person has trouble functioning.
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That would typically mean seeing,
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using their hands, or
they're in pain, which is rare.
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And then we would use steroids.
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So because the thing with steroids, they
decrease the time a patient has a relapse.
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What's important to understand is that
actually not treating an MS relapse is not
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dangerous in and
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of itself, because the body heals
the inflammation that was there.
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Okay, with or
without treatment that will be healed.
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But the thing is if a person is
having like trouble seeing or
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they can get into problem with that.
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Sometimes when patients
do have a relapse and
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they are not kind of
listening to their body.
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And they continue to do things
to maybe aggravate the symptom,
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that's not a great idea.
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So if somebody's having
tingling in their feet
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they might want to take the bus that day
instead of walking all the way there,
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just to give their body a break
until they can get better.
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A patient should always let us know when
they think they're having a relapse.
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First of all, I just, as a doctor,
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I would always tell a patient,
I like to worry about it with you.
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I don't want you to just be at home
worrying about that symptom by yourself.
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it is very important, cuz we need to make
sure we have you on the best treatment.
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Patients in the newer
treatments that we have out
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can expect a relapse very infrequently.
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On average, in our trials,
it's like one in every eight years.
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And so because of that, it is a sign
that maybe we need to have a patient on
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a different treatment if they're having
relapse on the treatment they're on.
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Patient education: Multiple sclerosis in adults (The Basics). UptoDate, 2017. (Accessed on December 22, 2017 at https://www.uptodate.com/contents/multiple-sclerosis-in-adults-the-basics)
Managing Relapses. New York, NY: National MS Society. (Accessed on December 22, 2017 at https://www.nationalmssociety.org/Treating-MS/Managing-Relapses)