If you feel fine for weeks or months but your multiple sclerosis symptoms pop up again, you probably have what doctors call a relapse or flare-up. There are a lot of ways to treat or prevent them.
What Are the Symptoms of a Flare-Up?
Everyone's flare-ups are different. Some are mild. Others are severe.
During a flare-up, you'll get new symptoms, or the ones you already have will get worse.
You might have one or more of these problems:
What Causes Flare-Ups?
Flare-ups happen when inflammation in your nervous system damages the layer that covers and protects nerve cells. This slows or stops nerve cell signals from getting to the parts of your body where they need to go.
If you have relapsing-remitting MS, you may have flare-ups followed by symptom-free periods called remissions. To be a true relapse, the symptom must start at least 30 days after your last flare-up and should stick around for at least 24 hours.
The exact mechanism that leads to a relapse is unknown, but is thought to be related to an increased overall immune response. There is some evidence that systemic infection (viral or bacterial), postpartum period, stress and assisted reproduction (infertility treatment) can be associated with a true flare. A flare can lead to more brain cell damage and demyelination.
An MS exacerbation needs to be distinguished from a pseudoexacerbation, which usually lasts less than 24 hours. Typical triggers of pseudoexacerbation include high body temperature, (fever/infection, too much exercise or activity), menses, new medications and stress. Usually removing the underlying stressor can help resolve the pseudoexacerbation. It is often difficult to distinguish an exacerbation from a pseudoexacerbation, so any new or worsening symptoms should be discussed with your doctor.
How to Prevent Flare-Ups
Take your medicines. The drugs your doctor prescribes slow your MS from getting worse and help prevent relapses. If you have side effects, don't just stop taking them. Ask your doctor about other options.
Stay healthy. A bout of cold or flu can set off your MS symptoms. A bladder infection can trigger either a flare or a pseudoflare so the same advice applies. Wash your hands with warm water and soap during the day, get your yearly flu shot, and avoid people who look sick. Stay hydrated. Ask your doctor for other ways to avoid bladder infections.
If you smoke, quit. It's bad for you in so many ways, and it can make your MS symptoms worse. Talk to you doctor about ways to break the habit.
Rest. You won't feel well when you're worn out. Sleep problems are common in people with MS. Symptoms like pain and muscle spasms can keep you up at night. Some of the medicines that treat MS interrupt sleep, too. Work with your doctor to get your symptoms under control so you can sleep. Adjust your medicines if they keep you awake.
Ways to Treat a Flare-Up
Your symptoms might go away on their own if they're mild. Even so, let your doctor know what's going on.
Treating symptoms can shorten your flare-ups and help you recover faster. The goal is to bring down the inflammation that caused your symptoms.
Your doctor will likely prescribe a steroid drug. Steroids curb inflammation and can help you get over a relapse faster. But they can’t undo the damage that’s been done or slow the disease. Methylprednisolone is the most common steroid used for this. You might take it as tablets or get it through an IV in a hospital or your doctor’s office.
Some people can't take steroids. Others are bothered by side effects, which include weight gain, mood changes, trouble sleeping, and upset stomach. Another option is ACTH gel (Acthar gel). It's injected into your muscle or under the skin. ACTH triggers your adrenal gland to release hormones that bring down inflammation.
For a very severe flare-up that doesn't get better with steroids, you can try plasma exchange. First, a health care professional will take some of your blood. The liquid part, called plasma, is taken out. It's replaced with a substitute plasma fluid or with plasma from a donor. Then, the blood is returned to your body.
During a relapse, you might feel more tired than usual. Try to get enough rest. Also avoid heat, which can make your symptoms worse.
What to Do After a Flare-Up
You can recover fully after a relapse, but it might take weeks or months to get over all your symptoms. If you had a lot of nerve damage, some symptoms might not fully go away.
You may need extra help to get back to your normal life. A rehab program can put you back on track. Your rehab team will help you with:
- Dressing and personal care
- Home chores
- Problems with thinking and memory
If you also see a neurologist (a doctor who specializes in problems with your brain, spinal cord, or nerves) for your MS, let them know about your flare-up. It could affect which medicines they prescribe for you.