Multiple Sclerosis Relapse or Pseudoexacerbation? Part One

by Lisa Emrich Patient Advocate

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.

Thankfully, this was a temporary experience without any lasting damage.
When we talk of pseudo-exacerbations, we are certainly speaking of real symptoms as there's nothing "fake" about the experience.

Heat-Sensitivity and Pseudoexacerbation

Many people with MS experience a temporary worsening of their symptoms when the weather is very hot or humid or they run a fever, sunbathe, get overheated from exercise, or take very hot showers or baths. For example, some people notice that their vision becomes blurred when they get overheated a phenomenon known as Uhthoff's sign. These temporary changes can result from even a very slight elevation in core body temperature (one-quarter to one-half of a degree) because an elevated temperature further impairs the ability of a demyelinated nerve to conduct electrical impulses.

Heat-sensitivity and ways to manage it will be discussed in greater detail in Part Two.

SOURCES: Practical Insights for Multiple Sclerosis Patients, MS Perspectives, Fall 2008
"Exacerbations" as discussed by National Multiple Sclerosis Society.
"Heat and Temperature Sensitivity" as discussed by National Multiple Sclerosis Society.

For Further Information: MS Essentials 01: Managing Relapses presented by MS Society UK, 2007.

Lisa Emrich
Meet Our Writer
Lisa Emrich

Living with multiple sclerosis and rheumatoid Arthritis, Lisa Emrich is an award-winning, passionate patient advocate, health writer, classical musician, and backroad cyclist. Her stories inspire others to live better and stay active. Lisa is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers. Lisa frequently works with organizations in support of better policies, patient-centered research, and research funding. Lisa serves on HealthCentral’s Health Advocates Advisory Board, and is a Social Ambassador for the MSHealthCentral Facebook page.