Relapses and the Progression of MS

One of the biggest challenges of living with multiple sclerosis is coping with the constantly changing state of the disease. It’s not unusual to encounter periods of severe symptoms followed by remissions. Knowing what to expect, how to manage relapses, and how to cope with the overall progression of the disease goes a long way. This knowledge can help you live the highest possible quality of life with MS.

It’s no small issue. MS presents serious lifestyle and treatment challenges. In the end, each patient must find a unique strategy and therapy approach. If you’ve received a diagnosis of MS—or if a doctor suspects that you might be developing the disease—here is what you need to know in order to live with the disease more effectively.

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What a Relapse Is and Why it Occurs

A relapse of MS is when your immune system attacks the myelin surrounding your nerves or spinal cord. This attack disrupts the signals in the central nervous system, causing weakness, numbness, or clumsiness. The lesions, or areas of damage, can be seen on magnetic resonance imaging (MRI). This may result in a worsening of existing symptoms or cause entirely new symptoms. In many cases, these relapses occur without warning and the onset of symptoms takes place quickly. A relapse is defined as an episode that occurs at least 30 days apart from another event. A relapse lasts at least 24 hours, but can run for days, weeks, or months.

How Relapses Affect You

Depending on the type of MS you have and your unique situation, relapses may occur regularly or take place months or years apart. Ongoing relapses typically lead to a worsening of MS. In fact, studies show that those who suffer even one relapse during the first two years of MS are at greater risk for more rapid progression of the disease. Consequently, it’s important to develop a treatment and therapy strategy immediately and revisit it periodically. Doctors often use a tool called the Expanded Disability Status Scale (EDSS) to measure the physical disability associated with MS. Although this scale is complex and somewhat difficult to use, it provides insights into where you’re at in the progression of MS.

Preventing and Treating Relapses

One of the most effective ways to combat MS is to use medications that help slow or control the progression of the disease. Over the last two decades, researchers have developed several medications—including teriflunomide (Aubagio), interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), glatiramer acetate (Copaxone), fingolimod (Gilenya), natalizumab (Tysabri), and mitoxantrone (Novantrone)—specifically designed for MS. These drugs reduce immune response and inflammation. Doctors also prescribe high-dose corticosteroids such as Methylprednisolone for three to seven days. These drugs modulate the immune system, shortening the exacerbation and speeding recovery. Like all drugs, there are side effects, potentially serious if taken long term or repeatedly.

Other Approaches

A 2012 study published in Neurology showed that vitamin D may help reduce MS relapses and lesions. In January 2011, the American Academy of Neurology issued new guideline recommendations that promote the use of plasma exchange to treat patients with severe MS relapses. It recommends doctors consider using plasma exchange as a secondary treatment for severe flares in relapsing forms of MS and related diseases.


During a remission, some symptoms of MS may remain. The National Multiple Sclerosis Society defines a remission as a return to the baseline prior to the start of the last exacerbation. However, relapses may cause additional permanent damage or impediments—even after a lesion is no longer active. In fact, studies show that residual impairment is fairly common following an exacerbation. Upwards of 40 percent of MS patients see some deterioration after a relapse. Consequently, it’s crucial to manage and control MS from the initial diagnosis and prevent attacks whenever possible.

Participate Actively

One of the best ways to ensure that you are maximizing the quality of your life as an MS patient is to actively monitor and manage your disease. Here are a few steps you can take:

  1. Become MS literate. Read and try to understand current research and advancements in treatments and medications.
  2. Monitor changes in the frequency and severity of relapses and episodes. This can help you and your doctor determine how your MS is advancing.
  3. Engage in an open, honest, and ongoing discussion with your doctor in order to understand when new or additional therapies may be helpful.

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