Top Ways to Control an MS Flare
When you’re living with relapsing-remitting multiple sclerosis (MS), the most common form of the disease, one of your top priorities is working to prevent relapses so you can keep living the life you want. Relapses—a.k.a. attacks or flares—are when you start experiencing new symptoms or old symptoms start to get worse, according to the National MS Society. These flares happen because of inflammation in the central nervous system, which is what leads to MS symptoms in the first place. We asked the experts for the best ways to prevent and manage MS flares.
Understanding MS Relapses
“Relapsing-remitting MS is characterized by typical relapses that correlate with a new inflammatory lesion developing in the central nervous system,” explains Thomas Shoemaker, M.D., a neurologist at Rush University Medical Group in Chicago. Relapses—which last between a day to several weeks—bring different symptoms depending on where the inflammation occurs. For example, says Dr. Shoemaker, the most “classic” relapses include optic neuritis (optic nerve inflammation, which can lead to vision loss), partial transverse myelitis (spinal cord inflammation, which can lead to numbness, tingling, or strength or walking issues), and brain stem syndrome (which can lead to things like double vision).
Find the Best Treatment
The number one way to prevent MS flares is to work with your neurologist to make sure you’re taking the right medication for you—and thankfully, there are more than a dozen to choose from. “Modern treatments tend to do an excellent job at preventing relapses,” says Dr. Shoemaker. Not only do disease-modifying therapies for MS reduce relapses, but they’re also shown to delay progression of disability due to MS and limit new disease activity overall, according to the National MS Society.
Follow Your Doc’s Orders
Once you and your neurologist have come up with a personalized treatment plan for your MS, it’s important to follow it to a T, and stay in close contact with your doctor. “It is important to maintain compliance and, if there is any issue with tolerating your medication, to discuss your concerns with your MS neurologist to determine a plan that may be better suited,” says Jacqueline F. Rosenthal, M.D., a neurologist at the Andrew C. Carlos Multiple Sclerosis Institute in Atlanta, GA.
Relapses Can Be “True” or “Pseudo”
Think you’re having a relapse? The first thing to do is let your doctor know. “The next step in a suspected relapse is to confirm it is a real relapse and not just a pseudo-relapse,” says Dr. Shoemaker. Basically, a pseudo-flare is when you have an episode of increased or recurrent MS symptoms that aren’t the result of active MS disease, but rather external factors, explains Dr. Rosenthal. “Pseudo-flares can occur in the setting of stressors such as over-activity, heat-exposure, or illness such as cold, flu, or urinary tract infections,” she says. “In this case, it is best to try to avoid known triggers, or if there is an underlying illness, to have it treated ASAP.”
Mild Relapses May Not Need Treatment
If you do have a true relapse, your doctor will want to go over your symptoms and work together to decide whether treatment is necessary, per the MS Trust. That’s right—not all true relapses will require treatment. For example, if your symptoms—such as mild tingling or numbness—aren’t majorly affecting your ability to engage in normal activities, then it’s usually OK to let the symptoms get better in their own time, says the National MS Society. Just make sure to keep your doctor in the loop.
Steroids Can Treat Severe Relapses
For more severe MS flare-ups, like those that involve things like vision loss, severe weakness, or anything that gets in the way of your ability to function or move safely, your doctor will likely prescribe treatment to help you get better faster. “If an MS flare occurs, depending on the severity of the symptoms, high-dose steroids may be considered to help promote faster recovery,” says Dr. Rosenthal. Usually, you’ll take them for three to five days, either in pill form or via an IV, per the National MS Society.
Plasma Exchange Is an Option
Some people with MS don’t respond well to steroids. Enter plasma exchange, or plasmapheresis. In this process, blood is taken out of your body, the is filtered out, and the rest of the blood and plasma replacement fluid are put back into your body, according to the National Institutes of Health. The idea is that removing the plasma could also remove antibodies in the blood that could be contributing to disease, says the National MS Society, and studies show this could be a helpful treatment for those in whom steroids aren’t cutting it.
Post-Relapse Rehab Can Be Helpful
If your relapse has led to struggles with mobility, speaking, memory, or other issues, your doctor may recommend you seek the help of a rehabilitation team to restore function. That might include physical or occupational therapy or speech therapy. These can be helpful for MS symptoms at any time after diagnosis, too—not just after a relapse. For example, occupational therapists can help you find solutions to getting daily tasks done that are made harder due to things like fatigue, muscle weakness, and other MS symptoms, says the National MS Society.
Lead a Healthy Lifestyle
While medications are the best option to help prevent MS flares, there are other things you can do to help manage different MS symptoms and avoid triggering pseudo-relapses. For example, if you’re experiencing fatigue—one of the most common MS symptoms, per the National MS Society—regular exercise and scheduled naps can help, says Dr. Rosenthal. Further, taking steps to avoid infection is a must, since that’s the top trigger of pseudo-relapses, according to the MS Trust. That means getting your annual flu vaccination, avoiding people who are sick, and washing your hands regularly.
The Bottom Line on MS Flares
While it’s not possible to predict every MS relapse, starting a disease-modifying medication and following your treatment plan are the best ways to reduce your risk. Also, it’s wise to keep a daily record of your symptoms, either on paper or using an app, says the MS Trust. While it may seem cumbersome to track these details, it can be a majorly useful tool in case of a potential relapse to help your doctor better understand what’s going on and get you the treatment you need faster.
How to Manage MS Relapses: The National MS Society. (2020.) “Managing Relapses.” nationalmssociety.org/Treating-MS/Managing-Relapses
Relapsing-Remitting MS Treatment Information: The National MS Society. (2020.) “Treating RRMS.” nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS/Treatment
MS Rehab Information: The National MS Society. (2020.) “Rehabilitation.” nationalmssociety.org/Treating-MS/Rehabilitation
MS Relapse Information: The Multiple Sclerosis Trust. (2019.) “Managing relapses.” mstrust.org.uk/about-ms/ms-symptoms-and-relapses/managing-relapses#what-should-i-do-if-i-think-im-having-a-relapse
MS Treatment Information: The National Institutes of Health. (2020.) “Multiple Sclerosis: Hope Through Research.” ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Multiple-Sclerosis-Hope-Through-Research#attacks
Plasmapheresis Information: The National MS Society. (2020.) “Plasmapheresis.” nationalmssociety.org/Treating-MS/Managing-Relapses/Plasmapheresis