When you have relapsing/remitting MS, having flare-ups (also called attack, exacerbation, relapse) can be a scary thing. No two relapses are the same, and it’s sometimes hard to find out if you have a pseudo-relapse, or a real relapse. Also, no two relapses are the same.
So what is an MS relapse?
New damage to the CNS (brain and spinal cord) upsets nerve signals, meaning new symptoms or the worsening of existing ones occur. Also, new or deteriorating old symptoms last longer than 24 hours, and they occur at least 30 days after a previous relapse. They can vary in length, severity and symptoms.
Remember no two people with MS are the same, therefore symptoms tend to be different for every person. Even when you’re in remission, you can still feel some symptoms. Being in remission doesn’t mean being symptom-free. It’s when you feel a change in symptoms, you might be having a relapse.
Clinicians use a concrete definition to identify MS relapses, meaning:
1. New symptoms appear or old ones get worse gradually or suddenly.
2. Symptoms must last at least 24 hours. If not, you may be experiencing a pseudo-relapse or another condition commonly mistaken for a relapse. Relapse symptoms can last days, weeks or even months.
3. Symptoms must occur at least 30 days after the last relapse. MS symptoms had to have been stable for about 1 month before symptoms became worse or new symptoms appeared.
4. There must be no other explanation for the symptoms. Some other conditions, like the flu, can be mistaken for an MS relapse. In a true relapse, symptoms are not connected with any other cause and do not get better when that cause is identified and treated.
Some MS relapses are obvious—especially when symptoms have more of an impact on your life. Other times, relapses may not be as clear. For example, if you suddenly have trouble seeing, you may realize that you’re having a relapse right away. If you are feeling more tired than usual, it may be harder to know if this is a relapse.
What isn’t a relapse?
The good news is that the symptoms of a pseudo-relapse often resolve quickly. If symptoms resolve within a day, the episode was not a true relapse. And if symptoms have another cause, like an infection, proper treatment of this cause will resolve the symptoms.
Symptoms of a pseudo-relapse are not caused by new damage to the central nervous system. Pseudo-relapses may be caused by exposure to heat or infection.
Symptoms caused by heat sensitivity are known as Uhthoff’s phenomenon. Nerve damage from MS can make you very sensitive to even small rises in body temperature, such as from sunbathing, a hot bath, or a fever. If you experience new symptoms or exacerbated symptoms during or after increased activity, first rest and cool your body. If symptoms get better, then you were experiencing a pseudo-relapse, not a true relapse.
Mild infections, including viral upper respiratory infections (such as colds) and urinary tract infections, can also cause a pseudo-relapse. Once these infections pass, symptoms should get better. More severe infections, however, can cause a true relapse.
Medications, both for MS and for other conditions, can also cause new symptoms. Be sure to discuss any medications you are taking with your healthcare provider.
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