Multiple Sclerosis Centers of Excellence
Relapse Management for Multiple Sclerosis
A relapse is a flare of new or worsening MS symptoms that lasts more than 24 hours, caused by fresh inflammation in the brain, spinal cord, or optic nerves. Relapses are unpredictable, and they can be mild or severe. The good news is that most relapses improve on their own over a few weeks, and treatment is available when symptoms are more disabling. Here is how relapses are checked and treated.
First, is it really a relapse?
Not every flare of symptoms is a true relapse. Infection, stress, and heat can make old symptoms worse for a while without new MS damage. This is called a pseudo-relapse, and it is treated by addressing the cause, not with steroids. If you think you may be having a relapse, pay attention to what you feel and how long it lasts, and note any other issues like a urinary infection, a cold, or major stress, since these can mimic a relapse.
Then call your MS provider. Depending on your symptoms, they may examine you, order blood or urine tests to check for infection, and sometimes an MRI. If your symptoms are severe - for example, you cannot walk, see, or urinate - do not wait; go to the emergency room.
Steroids: the main treatment
When a relapse causes bothersome or disabling symptoms, high-dose steroids are the usual treatment, given for three to five days. Steroids calm the inflammation and shorten how long a relapse lasts, but they do not change the long-term course of MS, and they do not improve how fully you recover. That is why mild relapses often need no treatment. You and your care team decide together, weighing how much the symptoms bother you against the possible side effects.
Steroids can cause side effects, most of them short-lived: trouble sleeping, mood changes, a metallic taste, an upset stomach, more appetite, fluid retention, and higher blood sugar, which matters if you have diabetes. Taking the dose in the morning helps with sleep.
Steroids: IV or pills?
For years, steroids for a relapse were given through an IV, into a vein. We now have strong evidence that steroid pills at the right dose work just as well as IV steroids, with similar side effects. This means many people can take their relapse treatment as pills at home instead of coming in for infusions. If you are getting IV steroids and would prefer pills, ask your provider whether pills are a good option for you.
If steroids do not help: plasma exchange
For a severe relapse that does not improve with steroids, a treatment called plasma exchange may be an option. It filters the blood and usually requires a hospital stay, with treatments about every other day for five sessions. Because it carries more risks than steroids, it is saved for serious relapses that steroids could not treat.
Rehabilitation
Whatever the treatment, rehabilitation often helps you recover. Physical, occupational, and speech therapists can help you regain abilities the relapse affected and manage any symptoms that linger after the inflammation settles.
When to Talk to Your Provider
Contact your MS provider promptly whenever you have new or worsening symptoms that last more than 24 hours. Getting checked early helps your team rule out a pseudo-relapse or infection and decide whether treatment is needed. For severe symptoms you cannot wait on - loss of vision, trouble walking, or trouble urinating - seek emergency care right away.
Based on articles by Michelle Cameron, MD, PT, MCR; Alexis A. Lizarraga, MD, MS; and Rebecca Spain, MD, MSPH.
Additional Information
- Relapse Management for MS (podcast)
- Relapse Management for People with MS (podcast)
- National MS Society: Treating MS
- VA National Center for Health Promotion and Disease Prevention
