Email a Friend
Print ArticleDiagnosis: Multiple Sclerosis
When MS Attacks
Call it a flare-up, call it an exacerbation -- whatever you call it, you can't call it fun. Exacerbations of multiple sclerosis are the periodic, sudden worsening of symptoms that so many people with relapsing-remitting MS experience on a regular basis. You're walking along fine when you notice numbness in your right leg. Or suddenly you have double vision. If those symptoms last at least 24 hours, you're going through an exacerbation.
"Exacerbation is a more rapid evolution of new symptoms or worsening of old symptoms than just the overall progression of the disease by itself," says John Richert, MD, vice president for research and programs with the National Multiple Sclerosis Society. "It comes on over a period of hours or days, as opposed to a slow progression that occurs over months and years."
Inside an MS Flare-Up
What's going on inside the brain when someone with MS experiences a flare-up?
Generally, when you experience relapse symptoms it means that "there are new lesions forming in the brain or spinal cord that disrupt neural transmission -- literally, new disease activity," says Patricia Coyle, MD, professor of neurology at the State University of New York at Stony Brook and director of the Stony Brook Comprehensive MS Center.
But not all symptoms are tied to brain lesions. Fatigue, for example, usually doesn't signal a flare-up in the brain. Although extreme fatigue accompanied by a worsening of other neurological symptoms might be, says Coyle.
Sometimes, what feels just like an MS exacerbation really isn't one. An infection or fever can cause a temporary problem with nerve conduction in previously damaged areas of the brain, explains Coyle. So if you have the flu, you might experience symptoms that seem like a flare-up. "It's not actually a sign of a new lesion, but rather temporary disruption in areas of old damage where nerve impulses were conducting normally," she says. "If we treat the fever or the infection, then we should see a complete reversal to where the patient was before."
Managing MS Flare-Ups
But when it's a real flare-up, the good news is it can be managed. Most doctors treat multiple sclerosis exacerbations with high-dose steroids, most commonly given in a half-hour IV infusion daily for three to five days. You can also take oral steroids, but you'd have to take a lot of pills to get that same effective high dose, so most patients opt for IV.
"What can steroids do?" asks Coyle. "They can speed up the time frame of recovery from an acute relapse. Most experts don't think they affect the ultimate degree of recovery from a flare-up. That question probably requires further study. But you do recover faster with them than without them."
Of course, you don't have to take steroids. With a mild flare-up, says Richert, many doctors would advise people with multiple sclerosis to watch and wait to see if it gets better on its own. "But if you're really affected -- if you can't work, can't climb the stairs, can't drive the car, can't do the things you need to do in daily life -- that's a reason to try and get through it as quickly as possible."
del.icio.us
Important Safety Information
AVONEX (interferon beta-1a) is approved by the FDA to treat relapsing forms of Multiple Sclerosis (MS) to decrease the number of flare-ups and slow the occurrence of some of the physical disability that is common in people with MS. AVONEX is approved for use in people who have experienced a first attack and have lesions consistent with MS on their MRI.
AVONEX can cause serious side effects, so before you start taking AVONEX, you should talk with your doctor about the possible benefits of AVONEX and its possible side effects to decide if AVONEX is right for you.
Sometimes interferons, including AVONEX, make people feel sad. If you are taking AVONEX and feel unusually sad, you should tell a family member or friend right away and call your doctor as soon as possible.
Some people have had severe allergic reactions, a drop in their red or white blood cell levels, a drop in the cells that help form blood clots, heart problems, changes in their thyroid function, or seizures.
Your liver may be affected by taking AVONEX and a few patients have developed severe liver injury.Your healthcare provider may ask you to have regular blood tests to make sure that your liver is working properly. If your skin or the whites of your eyes become yellow or if you are bruising easily, you should call your doctor immediately.
AVONEX has not been studied in pregnant women. If you become pregnant while taking AVONEX, you should stop taking AVONEX immediately, tell your doctor, and consider enrolling in the AVONEX Pregnancy Registry by calling 1-800-456-2255.
Most people who take AVONEX have flu-like symptoms (fever, chills, sweating, muscle aches, and tiredness) early during the course of therapy. For many people, these symptoms lessen or go away over time. Talk to your doctor if these symptoms continue longer than the first few months of therapy, or if they are difficult to manage.
For more information, please see the patient Medication Guide and full Prescribing Information. This information is not intended to replace discussions with a healthcare provider.
