MS relapses: the basics

Since about 85% of people with MS have relapses, you've probably had personal experience with relapses. A relapse is a period where MS symptoms get worse or new symptoms appear. These symptoms may include fatigue, vision problems, bowel or bladder problems, abnormal sensations, or difficulty walking.

In order to be considered a relapse, this period must last for at least 24 hours, and must occur at least one month after the last relapse. Otherwise, it is considered a pseudorelapse – see "MS pseudorelapses: smoke and mirrors?" in this health feature. Most relapses develop over about a week, and resolve slowly over weeks to months. Relapses are also known as exacerbations or flare-ups.

So what is happening in the body during a relapse? An area of brain tissue becomes inflamed, leading to the destruction of myelin, the protective coating of nerve cells. This is also known as demyelination, and leads to the worsening of neurological symptoms. It is not known exactly why relapses occur, but this is part of the underlying disease for people with relapsing forms of MS.

Once the relapse is over, MS symptoms return to their baseline level (the level they were at before the relapse started). This is known as a remission. "Remission" does not mean that all MS symptoms have disappeared, just that they have gone back to their pre-relapse levels.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Dealing-with-Relapses

How are MS relapses treated?

Unfortunately, you can't stop a relapse in its tracks. However, drug treatment can make a relapse shorter and less severe. Relapses are usually treated with a group of medications known as corticosteroids. Some corticosteroids, such as methylprednisolone, are given by injection. Others, such as prednisone, are given by mouth. High doses are used. Treatment schedules vary, but usually treatment lasts for about four days.

Corticosteroid medications work by reducing inflammation, including inflammation within the brain. This reduction in inflammation helps relieve symptoms and shortens the relapse time. Unfortunately, corticosteroid treatment does not stop the relapse right away or change the course of the disease.

Like any drug treatment, corticosteroids may have side effects. Short-term side effects include mood changes, blurred vision, difficulty sleeping, a metallic taste in the mouth, upset stomach, and, in rare cases, psychosis. There are also long-term side effects, which can be a concern for people who need frequent corticosteroid treatment (such as people who often have relapses). Long-term side effects include osteoporosis, increased risk of infection, stomach ulcers, cataracts, and diabetes.

Another treatment, called plasmapheresis, may sometimes be used in cases where corticosteroids are not effective. In this treatment, a person's blood is removed and the liquid portion (plasma) is separated out. The plasma is replaced with fresh liquid and added back to the blood, which is then put back into the person's bloodstream. This theory is that the plasma contains molecules produced by the immune system. These molecules are believed to be involved in causing the relapse, so removing these molecules from the plasma should help to treat the relapse. Plasmapheresis is not yet universally accepted as a treatment; some studies have shown that it helps relapses, while others have shown no benefits.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Dealing-with-Relapses

Can medications prevent MS relapses?

Looking for a way to reduce relapses? There are medications that can make relapses less frequent. They are known as disease-modifying medications, and there are 8 available in Canada: Avonex® (interferon beta-1a), Betaseron® (interferon beta-1b), Copaxone® (glatiramer acetate), Extavia® (interferon beta-1b), Gilenya® (fingolimod), Rebif® (interferon beta-1a), Tecfidera™ (dimethyl fumarate), and Tysabri® (natalizumab). Disease-modifying medications can reduce relapse rates by about one-third.

How do these medications lower the risk of relapses? During a relapse, immune system cells known as T cells enter the brain, where they damage the myelin coating of nerve cells. T cells do their damage by producing harmful chemicals and by stimulating other cells to attack the myelin.

  • Interferons (interferon beta-1a and interferon beta-1b) work by blocking stimulation and growth of T cells and by making it more difficult for T cells to enter the brain.
  • Glatiramer is believed to work by changing the actions of T cells. It is thought that it changes T cells so that instead of causing damage, they actually reduce inflammation in the brain.
  • Fingolimod is believed to work by altering the way the body's immune system works. In MS, when white blood cells (lymphocytes) reach the brain and spinal cord, they are thought to cause the inflammation that contributes to the loss of myelin. Fingolimod may keep lymphocytes from reaching the brain and spinal cord.
  • Natalizumab works by preventing cells of the active immune system from reaching the brain.
  • It is unclear exactly how dimethyl fumarate works, but it is thought to stop immune cells and could be protective against damage to the brain and spinal cord.

All but two of the disease-modifying medications are given by injection. Avonex® is given once weekly into a muscle. Betaseron® and Extavia® are given under the skin every other day. Copaxone® is given under the skin each day. Rebif® is given under the skin 3 days a week. Tysabri® is given as an intravenous (IV) infusion (a slow injection into a vein) once every 4 weeks. Gilenya® is an oral capsule and is taken by mouth once a day. Tecfidera™ is taken by mouth twice a day.

  • Avonex®: flu-like symptoms, muscle aches, fever, chills, and weakness
  • Betaseron®: flu-like symptoms, injection-site reactions (irritation of skin around the area where the medication was injected), injection-site tissue changes, fever, chills, headache, and allergic reactions
  • Copaxone®: injection-site reactions, vasodilation (widening of blood vessels), chest pain, weakness, infection, pain, nausea, joint aches, and anxiety
  • Extavia®: injection site reactions, flu-like symptoms, rash, and fluid retention (swelling) in ankles or legs
  • Gilenya®: flu-like symptoms, headache, diarrhea, back pain, cough, and abnormal liver function tests
  • Rebif®: flu-like symptoms, weakness, fever, chills, joint aches, muscle aches, headaches, and injection-site reactions
  • Tecfidera™: flushing, diarrhea, nausea, and stomach pain
  • Tysabri®: dizziness, fever, headache, joint pain, nausea, vomiting, stuffy nose, sore throat, tiredness, and urinary tract infection

Talk to your doctor or pharmacist to find out more information on these medications and whether one may be right for you.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Dealing-with-Relapses

MS pseudorelapses: smoke and mirrors?

Sometimes, it can feel like you're having a relapse... only you're not! A pseudorelapse occurs when outside factors, such as hot temperatures, stress, or infections, cause MS symptoms to temporarily get worse. Pseudorelapses are also called pseudoexacerbations.

Pseudorelapses are often mistaken for MS relapses, but there are some important differences between the two. Pseudorelapses are caused by outside factors (such as temperature, stress, and illness), while relapses are caused by the underlying disease. With a relapse, there is new inflammation in the brain. With a pseudorelapse, there isn't. Pseudorelapses last for 24 hours or less, but relapses last longer, often for days or weeks. Pseudorelapses may happen frequently and close together in time, whereas relapses happen at least one month apart. And having pseudorelapses does not mean that your disease is getting worse.

So when your MS symptoms flare up, how do you know whether it's a relapse or a pseudorelapse? There's no way to tell for sure. But you can try to figure out whether you've been exposed to anything that could make your symptoms worse, such as:

  • heat – hot baths, hot tubs, or a day at the beach, for example
  • stressful situations – experts don't universally agree about the effects of stress, but many people with MS find stress makes their symptoms worse
  • an infection – which means you may also feel ill and have other symptoms such as nausea, vomiting, fever, or chills

Urinary tract infections (UTIs) can often bring on a pseudorelapse. If you feel a burning sensation while urinating, have an increased need to urinate, or are urinating more often, you may have a UTI.

If you can't pinpoint a cause, your symptoms have lasted more than 24 hours, or you are concerned about your condition, see your doctor to find out what's going on.

What can you do about pseudorelapses? Since pseudorelapses are caused by outside factors, such as temperature, infections, and stress, protecting yourself from these things can help prevent a pseudorelapse. Every person with MS is different, and it's important to get to know which things can trigger a pseudorelapse for you. This way you can avoid them or try to minimize the effect they have on you.

When you have a flare-up, try removing these triggers first. If you're out in the sun, go inside and cool down. If you think you might have an infection, see your doctor for diagnosis and treatment. If you're under stress, try to remove yourself from the stressful situation and give yourself time to relax. If the symptoms don't go away within a day, or if you are worried about your condition, contact your doctor.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Dealing-with-Relapses