Do longer Flare-ups cause more damage?

Hi Abby, That's a great question and this is my understanding. During an acute exacerbation, the blood-brain-barrier develops a leak which allows damaging cells into the CNS causing inflammation. This inflammation results in neurologic injury (sometimes with symptoms) and chronic damage to the myelin and axons. Corticosteroids help to decrease this inflammation and to close the leak in the blood-brain-barrier. The nerves should then no longer be under attack (we all hope). But depending upon how much damage might have occurred, it is hard to predict the speed and extent of recovery. You've already experienced some symptom improvement and that's great!! The body does try to repair damaged myelin on its own, recruiting young oligodendrocyte cells (yes I had to look up the spelling on that one) to repair the myelin sheath. Sometimes symptoms will resolve as this process takes place. How long that takes is unknown. I still have some residual symptoms from each attack but have regained function (ie. my left hand/fingers) through occupational therapy. Really at this point it is a "wait and see" game. I highly doubt that further damage is occurring, although it is annoying to wait. Keep in mind, however, that there are medications which can address bothersome symptoms, such as neurontin for sensory pain/buzzing, provigil or amantadine for fatigue, baclofen for spasticity, etc. I'm sorry that you're going through this right now and talk to your doctor about symptomatic treatment. Now go kiss those kids of yours and I hope you have a nice weekend.

Hi Abby!

 

Is this Abby from the blog world?  Just had to ask.

 

This is definitely a question for the neurologist to answer and the ultimate answer will rely upon any MRI's that you have.

 

I did ask my neurologist this type of question and I will pass on what she said as well as my personal experience.

 

My neurologist told me that the number of lesions and even the size of lesions does not predict disability.  Someone with fewer lesions...but well placed lesions...can have more damage than someone having more lesions and even having ones greater in size.  It just all depends.

 

As far as having a longer exacerbation...I had one which I felt was severe, lasing over a month, and it did not cause me to have any new lesions on my next MRI.  I was stunned.  So I am just one case study but I am thinking that there is no rhyme or reason to this disease and no one great predictor of disability. 

 

I think when you run into trouble is when the episodes never stop and there are no remissions in between. 

 

Take all of this with a grain of salt.  I am just another MS patient just like you.  Ask your neurologist or doctor, read any studies you come across, and use your best judgement.

 

I am glad you asked this question and I hope my answer helped some.

True the BBB is breached when having a flair. You want to try an lessen the chance that it will become irreversable. Most will use an solumedrol IV drip to head of damage due to the inflammation, resulting in less lesion(s)or one growth/expansion, and the axons and the mylin being spripped away therefore resulting in futher damaged. This is very important when dealing with optical MS problems. Time is indeed a factor, form onset to treatment...God Bless...John