What is a Relapse?

The definition of an MS relapse (or exacerbation) is the sudden onset of new symptoms or worsened symptoms that last for more than 24 hours and is separated from a previous relapse by at least 30 days.  It can be very mild or severe enough to interfere with a person’s ability to function at home and at work. No two exacerbations are alike, and symptoms vary from person to person and often from one relapse to another.  A relapse results from inflammation in the central nervous system which damages the myelin and disrupts the transmission of nerve impulses.

“Most exacerbations last from a few days to several weeks or even months,” states the National Multiple Sclerosis Society.

But the presence of worsened symptoms does not always signal a new relapse, as there are many triggers that can lead to a reappearance of old MS symptoms or bring on new symptoms that mimic a relapse.  Since the central nervous system doesn’t work as well at high temperatures in most people with MS, symptoms can emerge with a rise in body temperature due to triggers such as stress, infection, or a warm environment.

If your symptoms go away once your body temperature returns to normal or the effects of other triggers subside, you’re not having a relapse but rather what’s called a ”pseudoexacerbation” which look and act like real relapses, but are temporary and do not signal disease progression.

Triggers That Can Cause a Pseudoexacerbation

* Infection, especially Urinary Tract Infection
* Stress or pain
* Premenstrual syndrome
* Excessive exercise and overheating
* Exposure to the sun
* Sitting in a hot tub, whirlpool, or sauna
* Certain medications

Be aware, too, that MS symptoms often fluctuate from day to day.

Urinary Tract Infection and Pseudoexacerbation

I recently experienced a pseudoexacerbation with the onset of a urinary tract infection (UTI).  Before hand, I’d felt a spasm-like sensation in the lower abdomen.  Didn’t really think much of it at the time because I was not experiencing any pain (burning upon urination) or fever.

But when overwhelming fatigue kicked in, followed by increased weakness and shakiness in my legs, I became a bit distraught.  If this were a relapse, then it seemed to be developing into one of the worse yet to affect my legs and limb coordination.  In the least, it was developing at an extremely quick pace as compared to previous relapses.

However in contemplating the phone call to my MS nurse, I mentally went through the questions I knew she would ask.  A pivotal question which is always asked - “How is your bladder?  Any sign of a UTI?”

So, I called my primary doctor’s office and asked if I could stop by to get a quick urine test.  I did have to see the doctor but was also able to get started on antibiotics the very same day.  This infection took two rounds of antibiotics to eliminate it.  Then an additional week or so to regain the strength I had temporarily lost during the pseudoexacerbation.