Call it a flare-up, an exacerbation, an attack, or a relapse. Whatever you call it, it's not something you expect. When you have relapsing-remitting multiple sclerosis (MS), you can go days or years without major changes in your symptoms. Then, suddenly, things change.
You'll work closely with your doctor to feel better. You can also reset your schedule to take special care of yourself. Exercise, stretching, and relaxation can help you manage MS symptoms -- and they boost your mood, too.
Symptoms of a True Flare
Here's how to tell if you're having a relapse of MS, when the illness is active again:
- You develop a new symptom of MS. For example, you’ve never had vision problems before, and suddenly you can’t see clearly out of your left eye.
- A regular problem gets worse. Maybe you’ve had some numbness in your left leg before, but now you can’t feel anything below your knee.
- Your symptoms last for 24 hours or longer. A relapse means a change in your brain, called a lesion. "If a symptom lasts less than 24 hours, it’s something transient that’s not related to a new lesion," says Edward Fox, MD, PhD, director of the MS Clinic of Central Texas.
- Symptoms level off after a while and stop getting worse.
MS flares can last days, weeks, or even as long as a year.
"Then they usually do improve, but recovery can be quite slow," says Bruce Cohen, MD, of the Northwestern University Feinberg School of Medicine. You may recover completely, or you could have some permanent loss of function or sensation.
MS False Alarms and What Causes Them
Sometimes, you may fear you're having a relapse, but a different issue is to blame for your symptoms. Once the trigger is gone, your symptoms should clear up, too. You can have muscle problems, numbness, or blurred vision after the following triggers:
- Alcohol. One drink can worsen coordination for some people.
- Cold or flu. Fever or an infection can feel like a flare-up. MS symptoms go away fairly quickly after the illness passes.
- Heat or cold. Hot or humid weather, exercise, hot showers, and sunbathing can trigger symptoms such as blurred vision. Cold can bring on spastic muscles.
- Poor sleep position. Morning numbness that goes away after you shake it out is not likely to be a flare-up, even if it happens every day. You just slept wrong.
Ordinary Fatigue or MS Relapse?
If you’re overworked, stressed, or not getting enough sleep, MS symptoms may trouble you more than usual. Rest and take extra time for yourself to get back on track.
If fatigue goes on even after you’ve rested -- especially if it’s extreme and keeps you from your regular activities -- check with your neurologist. Continued fatigue can be a sign of a flare-up.
How to Prevent a Flare
Nothing can completely prevent relapses of MS. However, starting medicine right after you're diagnosed with MS helps reduce how many flare-ups you have.
In addition to taking your medicine as directed, these steps may help.
- Closely track your symptoms. "If you notice subtle breakthrough events, it may mean that your medication isn’t working for you, and we need to make a change," says Cohen.
- Stop smoking. "Smoking is extremely bad for MS," says Fox. Smokers lose brain tissue much faster than those who don't smoke, he says. Ask your doctor about nicotine patches, gums, or lozenges. They don't seem to cause the same damage as tobacco and can help you kick the habit.
- Live healthy. Eat a balanced diet. Exercise most days of the week. Try to lower the stress in your life. You'll be healthier, which may make it easier to manage MS. Working out and relaxation may also help control your symptoms.
Treatments
Ask your neurologist how quickly you should call when you notice new symptoms. Some may require more than simply getting extra rest or using other coping strategies on your own.
These are the ways your doctor will usually treat a flare-up.
- Steroids. If you've lost some vision or suddenly can't walk, your doctor may suggest this type of drug. "Steroids [help] make the patient better faster," says Mark Keegan, MD, of the Mayo Clinic. You'll need an IV for three to five days, or a lot of pills over a few days.
- Physical therapy. These precise exercises help you recover the use of a hand or leg. Fox says PT works especially well while you're taking steroids. The combination helps you get back to your normal strength and motion.
- Plasma exchange. This may help treat a severe flare-up -- for example, you were walking fine and now you can’t walk at all -- when high-dose steroids aren’t working.
With plasma exchange, some of the blood is removed from your body. Your blood cells are separated from your plasma. The blood cells are then mixed with another fluid that replaces the plasma and transfused back into your body. Doctors think it helps some people because it removes antibodies in the plasma that may cause problems in MS.
- Watchful waiting. When symptoms are annoying but not severe, like a little numbness in your hand, you may choose to just watch them closely and see if they get better.
Talk with your doctor about what's right for you. You both may decide to avoid the hassle and side effects of steroids and just wait for the flare-up to go away.
"Steroids speed the healing of a relapse, but they don’t create healing that wouldn’t have occurred otherwise," Fox says. So you’ll recover just as much -- or as little -- without the steroids as you would with them.
Take care of yourself during a flare-up. "If it feels like you need more sleep, get more sleep," Fox says. But don't remain completely still. While the flare may limit your activities, you can -- and should -- still go about your daily business as much as possible. Maintain a healthy lifestyle, and pay attention to the signals your body is sending.
