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. Read Part One and Part Two of Multiple Sclerosis Relapse or Pseudoexacerbation? for more information.
It is also possible to have symptoms which are due to an underlying medical condition, such as a thyroid problem, a vitamin deficiency, migraine headaches, or anemia, rather than MS---but it can be hard to tell the true cause. For instance, you might think that vision changes are related to your MS, but in fact they may be caused by your migraines.
What to Do If You Have a Relapse
The best thing you can do to manage your MS is to stay attuned to your body and become familiar with the pattern of your symptoms. Call your MS clinician if you have new symptoms or an old symptom comes back and gets more severe over time--for instance, if you have tingling in your arm in the morning and by the next day one whole side of your body is tingling.
Questions to Ask Yourself and Share with Your MS Clinician
What is the symptom? * Where is the symptom? * When does the symptom occur?
How long have I had it? * Have I ever had this symptom before?
Has it come and gone, come and gone and come back, or come and stayed for 24 to 48 hours or more?
Has the symptom worsened since it started? * Has it started in one area and spread to another area?
How severe is the symptom? * How does the symptom affect my ability to perform everyday activities?
Has the symptom improved on its own since it started? * What have I done to try to relieve the symptom? * Did it help?
Do I have the flu or an infection? * Have I become over-heated?
How are MS Relapses Treated?
The good news is that not all exacerbations require treatment. Mild sensory changes (numbness, pins-and-needle sensations) or bursts of fatigue that don’t significantly impact a person’s activities can generally be left to get better on their own. If they don’t, or they expand into other symptoms, the relapse may need to be treated with a course of intravenous steroids.
For severe exacerbations (involving loss of vision, severe weakness or poor balance, for example), which interfere with a person’s mobility, safety, or overall ability to function, neurologists may recommend a short course of high-dose corticosteroids to reduce the inflammation and bring the relapse to an end more quickly. The most common treatment regimen is a 3-5 day course of intravenous Solu-Medrol® (methylprednisolone). High-dose oral Deltasone® (prednisone) may also be used.
Most people are able to receive IV treatment on an out-patient basis, either at home or in a doctor’s office. In some situations, hospitalization may be recommended or required. Depending on the physician’s preference, the patient’s condition, and the length of the treatment, the IV steroids may be followed by a one- to two-week tapering dose of oral steroids. Corticosteroids, however, are not believed to have any long-term benefit on the disease.
Corticosteroids should always be taken under a doctor’s supervision. Possible side effects include stomach irritation, elevation of blood sugar, water retention, restlessness, insomnia, and mood swings. Most patients tolerate the treatment well. Even with short courses of IV steroids, the physician may need to prescribe medications to help the person sleep and minimize stomach discomfort.
For 10 tips on how to make the Solumedrol experience go more smoothly, see Beginner’s Guide to MS: Solumedrol, It’s All the Rage!!
Any Precautions When Using Steroids?
Corticosteroids can stimulate the appetite and increase water retention, so follow a low-salt and/or potassium-rich diet and watch your caloric intake. They may also affect the blood sugar levels of diabetic patients. If you notice a change in your blood or urine sugar tests, be sure to speak to your doctor.
Steroids can lower your resistance to infection and make any infection you get more difficult to treat. Contact your doctor if you notice any sign of infection, such as sore throat, fever, coughing, or sneezing. Avoid close contact with anyone who has chicken pox or measles. Do not have any immunizations after you stop taking this medication until you have consulted your physician. People living in your home should not have the oral polio vaccine while you are being treated with corticosteroids since they might pass the polio virus on to you.
The risk of birth defects for women taking corticosteroids is not known. Overuse of corticosteroids during pregnancy or breast feeding while on steroids may slow the growth of the infant. Animal studies have demonstrated that corticosteroids cause birth defects and it may be necessary for you to stop nursing while taking this medication.
Corticosteroids may produce mood changes and/or mood swings of varying intensity. These mood alterations can vary from relatively mild to extremely intense, and can vary in a single individual from one course of treatment to another. If you have a history of mood disorders (depression or bipolar disorder, for example), be sure to share this information with your doctor. If you begin to experience mood changes or swings that feel unmanageable, contact your doctor so that a decision can be made about whether or not you need an additional medication to help you until the mood alterations subside.
SOURCES: Practical Insights for Multiple Sclerosis Patients, MS Perspectives, Fall 2008
National Multiple Sclerosis Society