What Is a Multiple Sclerosis Exacerbation?

Written by Robin Madell | Published on January 2, 2014
Medically Reviewed by George Krucik, MD, MBA on January 2, 2014

Worsening Symptoms

Multiple sclerosis (MS) is a disease of the central nervous system. MS can cause a wide range of symptoms, from numbness in your arms and legs to paralysis —in its most severe state. 

People with MS sometimes experience a flare-up of their symptoms. These relapses or attacks are called “exacerbations.”

Knowing Your MS Symptoms

In order to understand what an MS exacerbation is, you must first know the symptoms of MS. One of the most common symptoms of MS is a feeling of numbness or tingling in your arms and/or legs.

Other symptoms can include: 

  • pain or weakness in your limbs
  • vision problems
  • loss of coordination and balance
  • fatigue or dizziness 

In serious cases, MS can lead to a vision loss. This often occurs in just one eye.

Is This an MS Exacerbation?

Symptoms of MS can come and go over time. When symptoms return, it is considered an exacerbation. Another word for returning symptoms is “relapse.”

These symptom flare-ups can vary in their severity. According to the National Multiple Sclerosis Society (NMSS):

  • Each person’s exacerbations are unique.
  • You may experience different symptoms during multiple exacerbations.
  • Exacerbation severity can vary from mild to serious. 

Who Gets Exacerbations?

Most people with MS experience exacerbations, according to a study in the Annals of Indian Academy of Neurology (AIAN). In fact, when first diagnosed with MS by a doctor, around 80 percent of people are shown to be in a relapse, which indicates a flare-up.

In the study, researchers pointed out that most people will experience exacerbations throughout the course of their disease. 

MS occurs in stages. This stage of MS is called “relapsing-remitting.” Over time, multiple relapses can lead to disability.

Timing of an Exacerbation

How can you tell whether the symptoms you are having are regular features of your MS or if they are an exacerbation? 

According to the NMSS, attacks or flare-ups of symptoms only qualify as exacerbations if:

  • they occur at least 30 days from an earlier flare-up
  • symptoms last for 24 hours or longer

In fact, MS flare-ups can last months at a time. The majority stretch out for multiple days or weeks.

What Worsens Flare-ups?

Different studies have shown that stress can increase the occurrence of MS exacerbations.

In one study, researchers reported that when MS patients experienced stressful events in their lives, they also experienced increased flare-ups. The increase was significant: in the study, stress caused the rate of exacerbations to double.

Any event that participants believed caused them emotional stress was shown to result in this increase. Researchers considered the four weeks following a stressful event to be a high-risk time for exacerbations.

Treatments for Flare-ups

According to the NMSS, some MS exacerbations don’t need to be treated. If symptom flare-ups occur but don’t affect your quality of life, many doctors and neurologists will recommend a wait-and-see approach.

But some exacerbations cause more severe symptoms, requiring treatment.

Your healthcare provider may recommend:

  • corticosteroids. These can help bring down inflammation in the short-term
  • H.P. Acthar Gel. This is generally used only when corticosteroids have not been effective.
  • plasma exchange. This treatment is used only for very severe flare-ups when standard treatments have not worked.

Important Component of MS Treatment

Researchers report that most MS management now focuses on preventing new symptoms rather than treating worsening symptoms.

However, treating MS exacerbations is still an important part of managing the disease. This is especially true because when symptoms subside or are in remission, it doesn’t mean all symptoms are gone.

Some people with MS will have their symptoms continue after an exacerbation. Your doctor can help you decide how to manage ongoing flare-ups.

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