Relapses occur less frequently than you might think.
Each patient’s experience with multiple sclerosis, or MS, will vary. Both the MS symptoms and the trajectory of the condition can be unpredictable from person to person. Learn more about the symptoms of MS here.
That said, experts have identified four typical “courses” of MS, the most prevalent two being relapsing-remitting MS and primary progressive MS.
“Relapsing-remitting MS is the most common form of MS,” says Michelle Fabian, MD, a neurologist at The Mount Sinai Hospital in New York City. “Eighty-five percent of people are diagnosed with it at onset.” (Here’s what age multiple sclerosis is usually diagnosed.)
Relapsing-remitting MS, or RRMS, includes clear attacks (relapses) of new or exacerbated symptoms, followed by periods of some or partial recovery (remissions). Some MS symptoms may come and go during remissions, while others may linger, according to the National Multiple Sclerosis Society.
Primary progressive MS, on the other hand, does not fluctuate but develops steadily over time. MS symptoms continue to worsen over the course of months or years. “It might kind of plateau or flatten out,” says Dr. Fabian, “but it doesn’t go away.”
The most common symptoms during RRMS attacks include visual blurring, dizziness, numbness, and weakness, according to Dr. Fabian. These symptoms are temporary and may go away or subside during remission.
“The reason why a patient has relapses is because they have these episodes of inflammation,” says Dr. Fabian. The inflammation attacks the myelin, or the insulating layers on the nerve fibers of the central nervous system. Most often, these attacks occur on the fibers of the brain, spinal cord, or optic nerve (which connects the brain to the eyes), and the resulting damage is a new lesion that produces or aggravates symptoms.
A new symptom on the body has to last for at least 24 hours to be considered a period of relapse. Doctors will also do an MRI, which must show a new lesion on the body that is consistent with MS.
Thanks to improved treatment for MS, attacks from RRMS are actually fairly infrequent. “In our trials, patients have relapses every one in eight years or less,” says Dr. Fabian. “A relapse should be a signal to a patient and doctor that they need to think about the treatment they’re on.” Here’s what doctors recommend to prevent and treat MS relapses.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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Relapse and remitting MS is
the most common form of MS.
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85% of people are diagnosed
with it at onset.
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Multiple sclerosis is a disease
of the central nervous system.
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It is an autoimmune condition, and so
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that means the immune system
is activated against itself.
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And so the immune system is the system
that we have in our body to protect
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against virus, bacteria,
any sort of infection.
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And instead of doing that, for some reason
in multiple sclerosis, it turns inward.
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And the immune system attacks the parts
of the central nervous system,
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the brain, the spinal cord,
and the optic nerve,
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which is the connection
from the eye to the brain.
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And so, the two main sort of MS
are relapsing-remitting MS and
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primary progressive MS.
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Primary progressive MS is a slow thing
that happens over months to years.
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So it's more of a gradual symptom.
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And then it doesn't typically go away.
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It might kind of plateau, flatten out.
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But it doesn't go away.
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In MS relapse is a patient
that has a new symptom
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that is somewhere on their body,
localized on their body.
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And it lasts longer than 24 hours.
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And it comes on usually over
the course of days to weeks, and
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then it goes way over days to weeks.
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The most typical symptoms
are visual blurring, dizziness or
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vertigo, numbness, and weakness.
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And all of those things in relapse and
remitting MS are usually temporary.
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The reason why a patient has
relapses is because they have
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these episodes of inflammation, okay?
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So we don't really understand why
a patient has the onset of a relapse.
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But for some reason, the immune system
turns on and the white blood cells go into
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the central nervous system and create
a new lesion in the brain or spinal cord.
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So when we diagnose relapse and
remitting MS, we listen to the patient and
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we hear their story.
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They have to have evidence
of at least one episode,
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a new symptom that was localized
somewhere in their body, lasted 24 hours.
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So they have to have
that clinical symptom.
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They also have to have
an MRI that matches MS.
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So that will show lesions, MS lesions
in those spots that are typical for MS.
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Relapses are actually very infrequent now
that we have very good treatments for MS.
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In our trials, patients have relapses
every one in eight years or less.
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And so a relapse should be
a signal to a patient and
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doctor that they need to think
about the treatment they're on.
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Multiple sclerosis (MS—adult). New York, NY: Mount Sinai Hospital, 2016. (Accessed on April 12, 2021 at https://www.mountsinai.org/care/neurology/services/multiple-sclerosis/what-is)
Primary progressive MS. New York, NY: National Multiple Sclerosis Society. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS.)
Relapsing-remitting MS (RRMS). New York, NY: National Multiple Sclerosis Society. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS.)Relapsing-remitting multiple sclerosis. Baltimore, MD: John Hopkins Medicine. (Accessed on April 12, 2021 at https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/relapsing-remitting_multiple_sclerosis_134,54.)