Treatment for MS Flare-Ups

If you have MS and you think you’re having a flare-up, call your MS doctor or nurse as soon as you can. They’ll ask about your general health, the symptoms you’re feeling, and any problems they’re causing. This will help them decide the best way to help you feel better and get through the flare-up.

Treatments

Sometimes your symptoms will go away on their own. If they don’t, your doctor might suggest steroids or another medicine.

Steroids are powerful anti-inflammatory drugs that can ease your symptoms and shorten your flare-up. They also can help you recover from one. But they can’t undo the damage that’s been done or slow down the disease.

You should start them as soon as your doctor confirms you’re having a flare-up. Methylprednisolone is the most common steroid used for this.

You might take the steroids as tablets, or your doctor might put them right into your bloodstream through a needle in your vein -- called an intravenous (IV) drip. It’s done in a hospital or your doctor’s office.

Steroids can cause side effects. They can be short- or long-term.

Short-term effects include:

  • Changes in your mood
  • Trouble falling asleep and other changes in your sleep
  • Nausea
  • Faster-than-normal heart rate
  • Metallic taste in your mouth
  • Bigger appetite
  • Weight gain
  • Flushed or red face
  • Swollen ankles
  • Acne

Long-term use of steroids can make your skin and bones thin (that’s called osteoporosis). It can also cause high blood pressure. On rare occasions, steroids can also damage your hips.

If you can’t take them because of the side effects or because they haven’t worked well for you, another option is Acthar gel. That’s a form of a hormone called ACTH. That helps your body make a different hormone that can fight your inflammation. You get it as a shot in a muscle or under your skin, and it goes into your bloodstream. You need one shot a day for 2 to 3 weeks.

Another option if steroid treatment doesn’t work for you is something called plasmapheresis (also known as plasma exchange or PE) and intravenous immunoglobulin (IVIG). Immunoglobulin is something your immune system makes to fight off infections and illness.

In PE, your blood is run through a machine that cleans it of substances that could be harmful. Then it’s returned it to you. Then IVIG adds healthy immunoglobulin to your blood.

The FDA hasn’t approved PE and IVIG as treatments for MS flare-ups. Clinical trials on them have had mixed results. Talk with your doctor to see if they’re an option for you.

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What Happens Next?

It can take months to get over a flare-up. Symptoms may go away completely, or you might have some for a long time. You also may have trouble with some things in your daily life. If so, your doctor may recommend rehabilitation, like:

  • Physical therapy to help you walk and move around
  • Occupational therapy so you can learn to do things safely and more easily
  • Cognitive rehabilitation to help with problems thinking and remembering
  • Speech-language therapy if you have problems with talking and swallowing

Even if you decide not to work with a therapist for rehabilitation, you should stay in touch with your MS nurse or doctor as you recover.

If you also see a neurologist (a doctor who specializes in problems with your brain, spinal cord, or nerves) for your MS, let him know about your flare-up. It could affect which medicines he prescribes for you.

WebMD Medical Reference Reviewed by Richard Senelick, MD on January 31, 2017

Sources

SOURCES:

Multiple Sclerosis Trust: “Understanding MS, Relapse.”

Multiple Sclerosis Association of America: “Acthar Gel,” “Treating Multiple Sclerosis Relapses.”

National Multiple Sclerosis Society: “Rehabilitation,” “Managing Relapses,” “MS Essentials For People Living With MS.”

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