Managing Relapses

Multiple sclerosis (MS) is a difficult disease to manage. Depending on the type of MS you have you may experience gradually worsening symptoms or relapses followed by remissions. You may have some specific questions if your form of MS involves relapse.

How do I know when I’m experiencing a relapse?

The main signs of relapse are new symptoms or a dramatic increase of existing symptoms. You’re probably experiencing a relapse if these changes last 24 hours or more and you have significant pain or are unable to do regular activities. You may feel more tired or wobbly. You may also notice some of the following:

  • increased problems with vision or speech
  • tingling
  • shakiness
  • problems using a limb normally

Your doctor might order an MRI to see if you have active lesions. Your doctor may also use the Kurtzke Expanded Disability Status Scale (EDSS) to assess disability. 

How are steroids typically used?

Doctors used steroids to treat MS relapses for years. However, there is no evidence that steroids slow the progression of the disease or prevent relapses. These drugs are still widely used to reduce inflammation, a practice that shortens most relapses.

The steroids used to manage relapses are intravenously (IV) administered methylprednisolone (Solu-Medrol) and oral prednisone (Deltasone). When steroids are given for short periods in high doses via IV they’re called “pulse” steroids.

There’s a gel form of steroids if those drugs aren’t effective. The gel is called ACTH (H.P. Acthar Gel). Your doctor might prescribe this if there’s a problem preventing you from taking IV medicines.  

High dose steroids given over a short treatment time produce the best results with the least side effects. Side effects you might have from steroids are:

  • stomachache
  • high blood sugar
  • water retention
  • restlessness
  • insomnia
  • mood swings 

How effective are disease-modifying drugs in preventing relapses?

Disease-modifying medications control or reduce the number of lesions and relapses. They have dramatically changed the outlook for MS patients. For example, over half of participants in a 10-year study taking glatiramer acetate (Copaxone) saw a decrease or only tiny increase of their baseline EDSS scores. They’re ideally prescribed as early as possible in your diagnosis.

Each disease-modifying drug works differently and has different side effects. It’s critical to understand the benefits and risks associated with any medication. It’s important to spend time with a doctor, discussing the type of MS you have, the course of the disease, how you’re affected by it, your lifestyle, possible risks and side effects, and which, if any, drugs are suitable. These FDA-approved drugs — AvonexBetaseronCopaxoneRebifGilenyaTysabri, NovantroneExtavia, and Lemtrada — have been proven to slow the progression of MS and minimize relapses.

Alemtuzumab (Lemtrada) was approved by the U.S. Food and Drug Administration in late 2014. Clinical trials showed a significantly lower relapse rate for people on this drug versus those on an older disease-modifying drug, interferon b-1b (Rebif).

Should I consider alternative therapies?

There are a variety of complementary and alternative therapies (CAM) used by people with MS. These include:

  • exercise
  • supplements
  • special diets
  • meditation
  • medical marijuana

These techniques are considered complementary when they’re used with your prescribed medical treatment. They’re considered alternative when they’re used instead of prescribed treatment. 

Success rates can’t really be tracked as each person has a different experience. Bear in mind that many CAM treatments aren’t well studied. And while medical marijuana is legal in many states, it is still federally illegal, a situation that could put you at risk. 

Keep your doctor informed about what you’re taking if you’re considering a CAM therapy. Don’t abandon conventional therapy and keep track of your experiences. NMSS has a form you can use to document the prescription, over-the-counter, and supplementary medicines you’re taking. Also consider keeping a journal of non-medical CAM treatments like exercise.

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