Managing a Relapse

A relapse is a sudden onset of new neurological symptoms, or significant worsening of existing MS symptoms. Relapses are also known as “episodes”, “exacerbations” or “flareups”. No two relapses are alike and symptoms vary from person to person and from one relapse to another. For example, the relapse might be an episode of optic neuritis (caused by inflammation of the optic nerve that impairs vision), or problems with balance or severe fatigue.

Some relapses produce only one symptom (related to inflammation in a single area of the central nervous system), while other relapses cause two or more symptoms at the same time (related to inflammation in more than one area of the central nervous system). They can range from mild to serious in severity.

To be medically considered a relapse, it must last at least 24 hours and be separated from the previous relapse by at least 30 days. There should be no other possible cause for the relapse, such as infection, recent surgery or overheating. Most relapses last from a few days, to several weeks or even months.

In the most common disease course in MS — called relapsing-remitting MS — clearly defined acute relapses are followed by remissions, as the inflammatory process gradually comes to an end. Going into remission doesn’t necessarily mean that the symptoms disappear totally. Some people will return to feeling exactly as they did before the exacerbation began, while others may find themselves left with some ongoing symptoms.

In MS, the immune system attacks the coating of nerves, called myelin, causing inflammation and damage. Messages passed along the demyelinated nerves are slower or blocked completely. This is what causes symptoms of MS, and in the case of a relapse, the flare up of symptoms.

Inflammation doesn’t always result in a relapse. It can occur in a part of the brain which doesn’t result in symptoms, or the brain may be able to adapt rapidly and re-route messages round an area of inflammation. When inflammation lessens, it’s also possible for the damaged nerves to be replaced, via a process called remyelination. This allows messages to pass along the affected nerves more easily and symptoms to gradually improve. 

If you think you’re experiencing a relapse, talk to your neurologist, MS Nurse or GP as soon as possible. Relapses can be a sign that your MS is active, so it’s important to report each one, even if you don’t think you need medical treatment. If your MS is becoming active, it may be necessary to consider starting a disease modifying therapy or switching to a different one. Your health professional will be able to assess your options and create a plan. They will also assess if you need to have immediate treatment for the relapse. 

Your health professional will ask about the symptoms you’re experiencing, when they started, what’s changed and how these symptoms are affecting you on a daily basis. They will also want to know if there’s anything happening that could be making your symptoms worse, such as signs of infection. Some women find that their MS symptoms worsen around the time of their period, so you may be asked about your menstrual cycle. 

Talk to your health professional about: 

• When your symptoms started to change and the pattern of this change
• What symptoms you’re experiencing
• The part of your body that’s affected
• If the symptoms have stopped you from doing anything that you can normally manage
• If you’ve been ill lately or had any symptoms of infection 
• Your current medication (if any), or if you’ve recently changed medication

If your neurologist, MS Nurse or GP has confirmed you’re experiencing a relapse, they’ll be able to recommend if you need treatment for the relapse itself, or for the symptoms. 

Milder, sensory relapses, such as tingling or numbness, will often improve on their own and you may not require medication. Other relapses involving mobility, balance or visual disturbances might benefit from immediate treatment. 

If you’re going through a relapse, it’s important to remember that it will usually settle down of its own accord. It’s likely that you’ll feel unwell and more tired while you’re recovering from your relapse. This can have an impact at home and/or at work, so ask for help, make adjustments or take an extended break if suitable.

Not all relapses require treatment. Your health professional will advise a suitable treatment plan based on your discussions with them.

Some treatment options include:

Corticosteroids

If your relapse is having a significant effect on your daily life, your health professional may suggest you take a short course of corticosteroids. They will discuss the pros and cons of taking corticosteroids with you, to together help on the best course of action for your situation. 

These medications speed up recovery from a relapse by reducing inflammation and ideally, should be started as soon as possible after your relapse has been confirmed. Taking corticosteroids however, won’t affect how well you recover in the long term and won’t affect the course of your MS. You usually take corticosteroids as tablets or through an intravenous infusion (drip) in a hospital clinic/infusion centre or home nursing service. 

Disease Modifying Therapies (DMTs)

Disease modifying therapies are a group of treatments for people with relapsing remitting MS (RRMS), which help reduce the frequency/number and severity of relapses. They have no immediate effect on a current relapse, rather they aim to be preventative for the future. 

Rehabilitation 

Whether or not you’re prescribed corticosteroids, there may be other treatments to help you cope with your symptoms and recover faster from the relapse. These might include medication for MS symptoms, physiotherapy, occupational therapy to support you at home or at work, neuropsychology, speech and language therapy. 

Depending on the severity of your relapse, you may be offered rehabilitation at a day rehabilitation centre or as an inpatient at a hospital. For more severe relapses, you may need help from community care services, for example, with aspects of your personal care or meal preparation.