Multiple Sclerosis Relapses
Relapses, also referred to as exacerbations, attacks, flare-ups, episodes, or bouts, are initially experienced by most people diagnosed with multiple sclerosis (MS). Relapses occur with relapsing-remitting, progressive-relapsing, and sometimes secondary-progressive forms of MS. Relapses do not occur with primary-progressive MS, although patients may experience day-to-day fluctuations in how they feel.
During a relapse, inflammation is occurring along the nerves and the myelin, causing patients to have a temporary worsening or recurrence of existing symptoms and/or the appearance of new symptoms. This can range from a few days in duration to a few months, followed by a complete or partial recovery (remission). Acute physical symptoms and neurological signs must be present for at least 24 to 48 hours, without any signs of infection or fever, before the treating physician may consider this type of flare-up to be a true relapse.
A pseudoexacerbation is a temporary worsening of symptoms without actual myelin inflammation or damage, brought on by other influences. Examples of these influences include other illnesses or infection, exercise, a warm environment, depression, exhaustion, and stress. When symptoms flare, checking for a fever is important, since even a minor infection and slight increase in temperature can cause symptoms to appear.
Urinary tract infection (UTI) is the most common type of infection to cause a pseudoexacerbation. Additionally, people with “heat-sensitive” MS will experience a temporary increase in symptoms when their body temperature rises, often after exercise. Many heat-sensitive individuals may opt to avoid hot tubs, saunas, or other situations that can raise the body’s temperature. Cooling the body can help lessen the negative effects of heat and humidity on a person with MS, and specially designed cooling apparel is available to help cool the body. MSAA’s Cooling Distribution Program offers cooling vests and accessories for individuals diagnosed with multiple sclerosis.
Relapses are usually treated with a high-dose course of powerful corticosteroids (a type of steroid) over a period of three to five days. These are given by intravenous (IV) infusion, administering the drug directly into the bloodstream for a quicker response. Administration may be performed at a hospital, infusion center, or sometimes at home. Some doctors prescribe oral steroids after the high-dose treatment, to ease the patient off of the medication. These are usually tapered over one to two weeks.
For individuals who are not able to tolerate the side effects of steroids, who have found that previous treatments were not effective, or who may have difficulty getting timely medical support for IV infusions, Acthar® Gel and Purified Cortrophin® Gel are both FDA-approved to treat MS relapses as alternatives to corticosteroids. These products consist of a purified form of the hormone adrenocorticotropin (ACTH) in gelatin. Each is given via injection either into the muscle or under the skin, and the gel enables it to be absorbed slowly into the bloodstream.
For more information about MS relapses, please access MSAA’s MS Relapse Toolkit, which is available in both an English version and a Spanish version.