Am I Having an MS Relapse?

Symptoms aren't always a sign of disease progression

Am I Having A Multiple Sclerosis Relapse?
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In people with multiple sclerosis (MS), a relapse is either the worsening of symptoms you already have or the appearance of new symptoms. It is typically confirmed by the development of a lesion on your brain or spinal cord and is considered a sign that your disease is progressing.

In the course of managing your disease, it is often difficult to know if you are experiencing true symptoms of MS or are simply having an off day.

At other times, you may begin to wonder if a sudden flare-up is incidental or the sign of a worsening condition. Not knowing only make matters worse, adding anxiety and depression to the long list of possible symptoms.

Understanding MS Relapse

MS relapses are caused by inflammation in the central nervous system which further damages the protective coating that insulates nerves, known as the myelin sheath. By stripping away this protective layer, the lines of communication between nerve cells are effectively disrupted, causing an array of neurological symptoms depending on the location of the damage.

In the most common course of the disease, referred to as relapsing-remitting MS (RRMS), a period of acute symptoms will be followed by a period of remission during which time any inflammation will gradually subside and end. This doesn't mean, however, that all symptoms will disappear. In some cases, the symptoms will persist even during remission (albeit at a relatively steady level with only occasional ups and downs).

In strict medical terms, an MS relapse occurs when a person experiences one or more new neurological symptoms or the worsening of one or more old symptoms for at least 24 hours. In addition, the current attack must be separated from a prior attack by at least 30 days to meet the criteria for a true relapse.

When Symptoms Are Not a Relapse

Not all flare-ups are relapses. A pseudoexacerbation, for example, is the temporary worsening of symptoms caused by external factors, most often heat. When the external conditions normalize so, too, do the symptoms. Infections and physical or emotional stress are also common causes of pseudoexacerbations.

The same applies to paroxysmal symptoms of MS. These are the symptoms that appear suddenly, last for a few seconds or minutes, and then disappear just as quickly. Paroxysmal symptoms may occur as a once-off event or repeat in cycles over the course of hours or days. In some cases, the recurrent symptoms may take months to fully resolve.

But even recurrent symptoms like these don't constitute a relapse. They don't so much occur because of a progression of the disease but rather because of the existing nerve injury.

When to Contact Your Doctor

Knowing the difference between a relapse, a pseudoexacerbation, or a paroxysmal symptom is not an easy thing. Like the disease itself, the symptoms of MS are often erratic and unpredictable. Even doctors sometimes have a hard time distinguishing the difference.

In situations like these, the only real way to answer these concerns is by getting an MRI to see if there is any evidence of new lesions.

But, at the same time, it's not always necessary to do so. Depending on what you're experiencing, your doctor may simply want to know if the symptoms are interfering with your ability to function and/or your quality of life. It's a subjective assessment but one that's central to the management of your disease and your long-term well-being.

With that being said, even if there is evidence of relapse, your doctor may still not recommend treatment. Fatigue or mild sensory changes which don’t impact a person’s life can often be left to resolve on their own.

The decision to treat must ultimately be based on whether the benefits of treatment (usually with the drug Solu-Medrol) outweighs the side effects and complications one can experience.

A Word from Verywell

It's wise to be watchful of your condition, but don't let MS take over your life by worrying if every symptom is a sign of relapse. Try instead to maintain a healthy lifestyle with plenty of rest while adhering to any treatment you may be prescribed.

If there are symptoms you can't explain, try first to avoid any triggers that may have caused them and see if that helps. If it doesn't, don't panic or assume the worse. Simply see your doctor and take it one step at a time.

Sources:

Birnbaum, G. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment (2nd Edition). New York City, New York: Oxford University Press.

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