If you feel fine for weeks or months but then your multiple sclerosis (MS) symptoms happen again, you probably have what doctors call a relapse or flare-up. The good news is there are 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 may have new symptoms or symptoms you already have may get worse.
You may have one or more of these:
- Balance problems
- Blurred vision or blindness in one eye
- Pins-and-needles feeling
What Causes Flare-Ups?
They can happen when inflammation in your nervous system damages the layer that covers and protects your 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, your symptoms must start at least 30 days after your last flare-up and stick around for at least 24 hours.
The exact mechanism that leads to a relapse is unknown, but it's thought to be related to an increased overall immune response. There's some evidence that systemic infection (viral or bacterial), postpartum period, stress, and assisted reproduction (infertility treatment) can be associated with a flare-up. That can lead to more brain cell damage and demyelination.
MS flare-ups are different from pseudo-flares. Those are a temporary worsening of symptoms brought on by external factors. Unlike flare-ups, pseudo-flares aren't linked to new damage from your MS. They usually last less than 24 hours. Typical triggers for pseudo-flares include high body temperature from fever, infection, too much exercise, or activity; getting your period; new medications; and stress. Usually, removing the underlying stressor can help resolve a pseudo-flare.
But it can be hard to tell the difference between flare-ups and pseudo-flares, so talk to your doctor about any new or worsening symptoms.
MS flare-ups can be caused by:
- Eating poorly
- Skipping medication
- Lack of sleep
How to Prevent Flare-Ups
To try to prevent a flare-up from happening:
Take meds as directed. The drugs your doctor prescribes help slow your MS from getting worse and help prevent relapses. If you have side effects, don't just stop taking them. One study found about 25% of MS patients who stopped taking their meds had a relapse. Certain meds for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions. Check with your doctor to see if there are meds you’re taking that could be interacting with one another, and if your current meds are right for you.
Stay healthy. A bout of cold or flu can set off your MS symptoms. A bladder infection can trigger either a flare or a pseudo-flare, so the same advice applies. In fact, infections cause a third of MS flare-ups. Wash your hands with warm water and soap during the day, get your yearly flu shot, and avoid people who look sick. Stay hydrated. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex. Ask your doctor for other ways to avoid bladder infections, including vaccinations.
Relax. In some people with MS, stress can bring on flare-ups. Find calmness with meditation, yoga, counseling, or anything else that's good for you and helps you unwind. In one study, MS patients reported their stress level was cut nearly in half after 6 weeks of yoga.
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 meds that treat MS interrupt sleep, too. Work with your doctor to get your symptoms under control so you can sleep. Adjust your meds if they keep you awake. Aim for 7 to 8 hours of sleep per night.
Stay cool. High temps may trigger a flare-up. If you’re affected negatively by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days. Take cool baths and/or run air conditioning. Try a hat or clothes that hold ice packs or frozen gel packs to stay comfortable. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.
Eat well. Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats. A healthy diet helps keep your immune system strong.
Steer clear of smoking. This is a major risk factor for flare-ups, and it can make your symptoms worse. If you smoke, your doctor can help you make a plan to stop.
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 may 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 your 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 may be ACTH gel (Acthar gel). It's injected into your muscle or under your skin. It triggers your adrenal gland to release hormones that bring down inflammation.
For a severe flare-up that doesn't get better with steroids, you might 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. Talk to your doctor about whether this would help you.
You can also treat a flare-up by using the same tips in the section above for preventing them. For instance, get plenty of rest and make sure to eat well.
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 meds they prescribe for you.