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.

Relapsing remitting MS (RRMS) is the most common type of this disease. With this type, MS symptoms can come and go over time. A return of symptoms can be classified as an exacerbation.

According to the National Multiple Sclerosis Society, an exacerbation causes new MS symptoms, or worsens old symptoms. An exacerbation can also be called a relapse, a flare-up, or an attack. Read on to learn more about MS exacerbations and how to treat and possibly prevent them.

Knowing your MS symptoms

In order to understand what an MS exacerbation is, you first need to know the symptoms of MS. One of the most common symptoms of MS is a feeling of numbness or tingling in your arms 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 also lead to vision loss. This often occurs in just one eye.

Is this an MS exacerbation?

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

According to the National Multiple Sclerosis Society, symptoms only qualify as exacerbations if:

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

MS flare-ups can last months at a time. Most stretch out for multiple days or weeks. They can range from mild to serious in severity, and you may have different symptoms during different exacerbations.

Who gets exacerbations?

According to some research, most people with RRMS experience exacerbations throughout the course of their disease. In fact, when first diagnosed with MS by a doctor, around 80 percent of people are having an exacerbation.

What causes or worsens exacerbations?

While you can’t prevent all exacerbations, there are known triggers that can prompt them. Two of the biggest offenders are stress and infection.


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

Keep in mind that stress is a fact of life, but do what you can to reduce it. Exercising, eating well, getting enough sleep, and meditating are all good ways to help lower your stress levels.


Studies have shown that common infections, such as the flu or a cold, can cause MS exacerbations.

While upper respiratory infections are often a fact of life in the winter, take steps to reduce your risk. This includes getting a flu shot if your doctor recommends it, washing your hands often, and avoiding people who are sick.

Treatment for exacerbations

Some MS exacerbations may not need to be treated. If symptom flare-ups occur but don’t affect your quality of life, many doctors would recommend a wait-and-see approach.

But some exacerbations cause more severe symptoms, such as severe weakness, and require treatment. Your doctor may recommend:

  • corticosteroids:These drugs can help bring down inflammation in the short-term.
  • H.P. Acthar gel: This injectable medication is generally used only when corticosteroids have not been effective.
  • plasma exchange: This treatment, which replaces your blood plasma with new plasma, is used only for very severe flare-ups when other treatments have not worked.

If your exacerbation is very severe, your doctor may suggest restorative rehabilitation. This treatment may include physical therapy or occupational therapy, as well as treatment for problems with speech, swallowing, or thinking.

Important part of MS treatment

Over time, multiple relapses can lead to disability. So, treating and preventing MS exacerbations is an important part of managing the disease. It can help improve your quality of life, as well as help prevent progression of the disease.

Work with your doctor to put together a care plan to manage your MS symptoms, those that occur both during exacerbations and at other times. And if you have questions or concerns about your symptoms or condition, be sure to talk to your doctor.