How to manage an MS relapse?

Multiple sclerosis is a disease of the central nervous system (spinal cord and brain). This means that the immune system (involved in fighting viruses and bacteria) attacks myelin (the protective sheath of nerve fibres), which plays an important role in the spread of nerve impulses from the brain to various parts of the body.

This autoimmune disease is generally diagnosed in young adults (between 25 and 35 years of age on average) and affects women more than men (¾ of those diagnosed are women). 

MS affects over 130,000 people in the UK. On average, almost 5,000 new cases are diagnosed in England alone each year.

The first signs suggestive of MS come in the form of exacerbations (also known as a relapse, attack, or flare-up).

What is an MS relapse?

Multiple sclerosis, in more than 8 out of 10 cases, is relapsing-remitting, i.e. it manifests itself with periods of "relapses" interspersed with periods of remission.

A relapse is characterised by the appearance (or reappearance) of neurological symptoms, or the worsening of pre-existing neurological symptoms, in the absence of fever or associated infection, for at least 24 hours, followed by the total or partial disappearance of these neurological symptoms. 
An episode of fever can lead to signs resembling a relapse.

In general, the signs of flare-ups set in within a few hours to a few days and last from a few days to two or three weeks.

Relapse symptoms can either fully subside without any after-effects, or be accompanied by after-effects without a return to a normal neurological state.

In most cases, there is complete recovery from each relapse at the onset of the disease. After a few years, neurological after-effects may appear after each flare (sensory, motor, sphincter or sensory discomfort).

On average, patients experience one relapse per year. Some patients may go for several years without any relapses, while others may have relapses several times a year. The same patient may go from a period of several attacks to a period of calm.

What are the symptoms of an MS flare-up?

Depending on the area of the central nervous system affected, the signs presented during an MS attack can be:

• Numbness and tingling: in the arms and legs

• Eye pain and vision issues: blurred, double or jumpy vision

• Motors difficulties: difficulty with balance or coordination, reduced mobility

• Fatigue: lack of energy or rapid tiredness,

• Incontinence: urinary or faecal, but also bladder irritation

• Facial paralysis, difficulty speaking or swallowing.

It is not easy to identify an acute MS relapse, as it depends on the range of potential symptoms associated with the disease. However, it is possible that two MS attacks may be accompanied by completely different symptoms depending on the area of the brain in which the inflammation is located.

Are there any factors that lead to the onset of an MS relapse?

It is difficult to say whether there are factors that can trigger a relapse of multiple sclerosis. However, there are several factors that could encourage an attack, such as an infection (flu, sinus, etc.) or high levels of stress (bereavement, divorce, etc.). 

Nevertheless, during pregnancy, it is very rare for a woman with MS to have a flare-up. The three months following childbirth can, however, be a period with a high risk of relapse, so it is important to be vigilant.

In addition, "live attenuated" vaccines (such as those against yellow fever, measles-mumps-rubella or chickenpox-zoster) are likely to cause an outbreak because they strongly stimulate the immune system to create a defensive response. These vaccines, while not totally contraindicated, are sometimes not recommended for MS patients. However, other types of vaccines do not pose any particular risk.

Finally, certain drugs such as anti-TNF alpha, which are prescribed to treat rheumatological diseases, can promote the occurrence of relapses.

Is there a way to prevent relapses?

There is no real way to prevent a relapse of multiple sclerosis. However, there are certain measures that are recommended for everyday life. 
At present, there isn't any conclusive evidence to suggest that special diets are effective, but it is recommended to avoid excess salt.

It is advisable not to smoke because of the harmful effects of cigarettes on neurons.
In addition, vitamin D deficiency (common in the general population) may promote more marked symptoms during an exacerbation. It is therefore advisable to supplement with vitamin D.

Finally, regular physical activity can help improve recovery after a relapse. It is therefore recommended that patients practise appropriate physical activities as regularly as possible.

How is an MS relapse treated?

There are three categories of MS treatments:

• those that act on the duration and the severity of relapses,
• those that reduce daily discomfort by treating the symptoms,
• and “background” treatments that act rather on the immune system.

To date, there is still no cure for MS.

If a symptom is bothersome and persists for more than a few days, it may be worthwhile to administer a dose of corticosteroids via an infusion. The main purpose of these infusions is to reduce the intensity and duration of the flare-up. They do not, however, influence (unlike systemic treatments) the course of the disease or the possible occurrence of after-effects.

Some relapses do not cause any major discomfort and can be treated with rest without corticosteroid infusions. Sick leave can be requested in this case.

An MS relapse is not an absolute emergency unless the condition is severe and seriously debilitating. If this is the case, it is best to contact your GP or neurologist.

Was this article helpful to you?
Share your thoughts and questions with the community by commenting below!
Take care!