Triggered: 8 Things You Can Do to Prevent an MS Relapse
When you have multiple sclerosis (MS), the ultimate goal of your treatment is to prevent having new symptoms, known as relapses. “New neurologic symptoms are a sign that the disease is not optimally treated,” says Mary Rensel, M.D., a neurologist at Cleveland Clinic’s Mellen Center for MS Treatment and Research. But sometimes, new symptoms, worsening symptoms, or even old symptoms coming back aren’t a true relapse. When this happens, it’s called a pseudo-relapse and Dr. Rensel says these are almost always caused by some type of infection.
Let’s Break Down Relapse vs. Pseudo-relapse
Timing and your symptoms can indicate whether you're having a relapse or a pseudo-relapse. In some cases though, you may need magnetic resonance imaging (MRI) to tell for sure. A pseudo-relapse is more likely if you’re having worsening pain or spasticity, you have an infection, or you start experiencing old symptoms again. And if your symptoms fluctuate and then go away, you’re probably having a pseudo-relapse. Be sure to contact your medical provider if new or worsening symptoms don’t resolve within 24 hours.
Relapse Prevention Isn’t an Exact Science
So is there anything you can do to keep a relapse or a pseudo-relapse at bay? Well, yes and no. “MS relapses are episodes that happen randomly and there’s no way for us to predict those or to identify what might be triggering them in a specific person,” says Paven Bhargava, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine in Baltimore. Still, there are things you can do—and potential symptom triggers you can avoid—that may help lessen your chances of a relapse or pseudo-relapse.
Keep Up Your Regular Care
The number one way to help prevent relapses is to make sure your MS is optimally treated by seeing your care team regularly, says Dr. Rensel. “Patients can have new lesions or new areas of inflammation in the brain but no symptoms,” she says. Consistent care allows your doctor to keep a close eye on your MRI results, especially if you’ve changed your MS medication, and treat any MRI changes before they’ve caused relapses or any permanent damage. Be sure to get your annual flu shot, too, since the flu can cause a pseudo-relapse.
Stay on Your Medications
It’s super important to keep taking your medications the way your doctor has told you to. You may not be able to tell for sure if they’re working, but that doesn’t mean they aren’t. Plus, disease-modifying medications play a huge part in staving off relapses. If you have concerns about side effects or you’re worried your medications aren’t doing what they should, talk to your neurologist about it. Remember that stopping your medications on your own can cause a relapse.
Get Enough Vitamin D
Some research suggests that low vitamin D levels are linked to MS relapses because vitamin D appears to calm down the immune system, says Florian P. Thomas, M.D., Ph.D., director of the Multiple Sclerosis Center at Hackensack University Medical Center in New Jersey. In fact, Dr. Thomas makes sure all his patients take vitamin D supplements and keep their levels high. If you aren’t already taking vitamin D, be sure to talk to your doctor before you start to make sure you’re taking the right amount.
Manage Your Stress
According to Dr. Rensel, one of the biggest relapse triggers is stress. “Stress management is a huge part of brain health,” she says. Learning how to cope with stress, whether it’s by going to therapy or by finding relaxing ways to unwind, can help your sense of well-being. Try activities like keeping a journal, coloring, doing a puzzle, learning to play an instrument, taking a walk, talking to a friend, or cooking. Whatever helps you blow off steam, make time to do it, especially during times of high stress.
Be Aware of Mood Disorders
Dr. Rensel says depression and anxiety can spark symptom flare-ups and relapses. “Mood disorders are very common in people with pediatric and adult MS, so getting them diagnosed and treated is imperative since they can cause patients to flare when they’re not optimally managed,” she says. This also applies if you’re already being treated for a mood disorder but you’re still not feeling as well as you should. If you’ve been feeling off for a couple weeks or more, give your primary care doctor or mental health provider (if you have one) a call.
Maintain a Healthy Diet
“Our brains need a healthy diet because they use a lot of vitamins, nutrients, and calories to work. Even though our brain is 2% of our body weight, it takes 20% of our metabolic needs,” Dr. Rensel says. “The healthier the diet is, the healthier the brain is.” There’s no specific diet that’s recommended when you have MS, but simply cutting down your intake of sugar and focusing on eating lots of fruits, vegetables, and whole grains is a good idea for anyone. Eating healthy also has the added advantage of helping you get to or maintain a healthy weight.
Make Physical Activity a Priority
A 2019 review of studies in Genes looked at the effects of physical activity on brain health and its role on certain conditions, including MS. They found that people with MS who regularly exercise experience less fatigue and depression and have a better quality of life than those who are inactive. The research also showed that exercise may reduce inflammation and brain degeneration and improve your memory and thinking. Along with all these benefits, regular physical activity can also help you maintain a healthy weight and decrease your risk of heart disease.
Ditch the Cigarettes
According to Cleveland Clinic, smoking has been shown to aggravate your MS symptoms, as well as increase the risk of your MS progressing faster, worsening brain lesions, and having other co-existing diseases (comorbities). Quitting can ease your MS symptoms and slow down your disease progression, not to mention help you feel better overall. And keep in mind too that, according to Dr. Rensel, the more comorbidities you have, the faster your disease will deteriorate. If you need help quitting, talk to your doctor about your options.
Relapse vs. Pseudo-relapse: International Multiple Sclerosis Management Practice. (n.d.) “What is an MS Relapse vs. Pseudorelapse?” imsmp.org/education/ms-relapse-vs-pseudorelapse
Vitamin D: Mayo Clinic. (2020.) “Vitamin D and MS: Is there any connection?” mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamin-d-and-ms/faq-20058258
Physical Activity Study: Genes. (2019.) “Physical Activity and Brain Health.” ncbi.nlm.nih.gov/pmc/articles/PMC6770965/
Smoking and MS: Cleveland Clinic. (n.d.) “Multiple Sclerosis & Smoking.” my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/ms-and-smoking