Multiple sclerosis is defined by the symptoms that recur or continue, depending on the type of MS the patient suffers. The most common type of multiple sclerosis is RRMS, or relapsing-remitting MS, which means that the symptoms are not constant but come and go (relapsing and remitting) throughout time.
Unfortunately, there are no cures for multiple sclerosis, but there are a number of treatments to help slow the progression of the disease, as well as to assist with reducing the episodes, or relapses, of symptoms. At the same time, since it doesn’t go away, having ways to manage those symptoms during a relapse can help improve quality of life for the patient.
What causes a relapse?
One of the first things that will assist in managing multiple sclerosis relapse is understanding the underlying causes. The disease can be extremely unpredictable, with symptoms appearing at any time. Flare ups occur when the inflammation in the central nervous system (CNS) damages the myelin – the protective substance covering the nerves, or the nerves themselves.
There are some things that patients with MS should avoid that are the most likely triggers of a flare up, which include:
- Stress – Try meditation or counseling to reduce stressors.
- Smoking – Patients who smoke show faster progression of the disease.
- Overheating – extremely hot showers or baths, saunas, and very hot days outdoors can worsen symptoms for a majority of patients.
- Specific medications – Some medications used for Crohn’s disease or even for rheumatoid arthritis can worsen the symptoms of multiple sclerosis.
- Drug interactions – Having too many different medications can lead to an interaction that, rather than helping relieve symptoms, worsen the effects of them.
- Stopping meds – Stopping the medications taken for MS can lead to more relapses and damage, so even if it seems that they “aren’t working”, it’s what the patient doesn’t see that matters with these meds.
- Fatigue – With an already compromised reserve of energy, losing sleep or too much activity can lead to exhaustion and fatigue, which can trigger symptoms.
- Infections – Perhaps the most common cause of flare ups in MS are caused by infection of some kind, which weakens the immune system that is already compromised by MS.
How often do relapses occur?
There is no definitive way to tell how often a relapse can occur. On average, patients with RRMS have relapses once or twice a year. Some people have a more active form of MS, which leads to more frequent or severe flare ups, while others, especially those on disease-modifying therapy drugs (DMTs) may see a relapse less frequently.
To be considered a true relapse, symptoms must appear for at least 24 hours, if not more, and the remission between episodes lasts at least thirty days. Exacerbation, or a flare up, that is not considered a relapse can occur due to excess stress, injury, and other external factors.
Managing a multiple sclerosis relapse
Due to the nature of the disease, no matter what medications and preventative measures are taken, multiple sclerosis symptoms will return in a relapse. In order to get through the rough patch of a relapse and maintain a somewhat normal life, patients can take steps to manage the symptoms during a relapse. There are five tried and true management skills that really work for MS.
- Be prepared. An MS relapse can occur without warning, so preparing in advance is critical. Patients should:
- Have all emergency contact and medical history information readily available and accessible.
- Know who to call for assistance with mobility and transportation, since symptoms often affect the ability to move and/or speak properly.
- Know the symptoms. While no two cases of MS are the same, a single patient will typically have similar symptoms in relapses. When the patient feels a relapse could be occurring, it’s important for them to monitor signs and symptoms very closely for at least 24 hours, since a single symptom could be due to some other underlying issue.
- Call the doctor. The doctor managing treatment of a multiple sclerosis patient needs to know about every relapse that occurs so he or she can better plan management and treatment. It can also assist in getting medication to help with pain or inflammation during the relapse.
- Tell others. Depending on the severity of the relapse, attending planned social events could lead to worsening symptoms, and trying to do everything alone could be detrimental, especially if mobility and coordination are compromised. Letting friends and family know about an MS relapse can relieve stress factors for social obligations and effectively get help when it’s needed.
- Control emotions. Anger, worry, stress, and depression can all factor into the reaction to a relapse. MS patients are already at higher risk of depression, so keeping an eye on emotional levels can seriously assist in calming the emotional turmoil that comes with such a rigorously debilitating disease. All of these emotions could also worsen symptoms. Deep breathing exercises, counseling, and meditation can all help control the emotional response to a relapse.
- Eat, exercise, and sleep. Getting enough restful sleep, eating a proper diet and maintaining a healthy weight, and exercising even during a flare up are all important factors both for prevention of a relapse and managing a current one. All of this promotes homeostasis in the body and helps to reduce the negative effects of the immune system.
Remission and recovery
While symptoms from a relapse will likely fade away (remission), the impact on a patient’s life can be significant. A person with MS recovering from a relapse will likely feel very tired and weak, sometimes even sickly, which can affect home and work.
- Recognizing limitations is crucial to a full recovery. If the patient can’t return to caring for all household activities, they should do what they are able and not push beyond the limits.
- If time can be taken off work, that helps, as do reduced hours. However, if a patient must work, speaking to a supervisor to make him or her aware of the condition and its repercussions can help.
- Asking for help should not feel like a burden. Friends, family, and coworkers may be able to pick up a little slack as the patient regains strength and ability to function at one hundred percent of their previous capacity.
- If emotions are overwhelming, the patient should consider calling the MS nurse managing their care or a counselor for assistance. Others around the patient may also need to be aware of their own emotions in dealing with the relapse.
One of the most important factors in managing relapses in RRMS is to remember that the symptoms won’t last forever. A patient will return to a status quo, especially when they have the right support to assure they aren’t trying to recover too quickly upon remission. People with MS must be patient and maintain healthy habits in order to better maintain quality of life both during and between relapses.