Understanding relapsing MS
Relapsing multiple sclerosis (MS) is a progressive disease that causes damage to the central nervous system (CNS). Relapses, also known as flare-ups or exacerbations, are new symptoms or a worsening of existing symptoms of MS, followed by a period of recovery called remission. Everybody experiences relapsing MS differently. The different ways these symptoms change over time are used to describe a few forms of relapsing MS.
Forms of
relapsing MS
Clinically isolated syndrome (CIS)
Clinically isolated syndrome (CIS) is the first episode where someone experiences neurological symptoms caused by inflammation and damage to myelin in the central nervous system. The episode is followed by complete or near-complete recovery. The episode must last for at least 24 hours to be considered CIS. While CIS is a characteristic of relapsing MS, it is not a relapsing MS diagnosis. People who experience CIS may or may not go on to develop relapsing MS.
Relapsing-remitting
MS (RRMS)
MS (RRMS)
Relapsing-remitting MS (RRMS) is the most common form of relapsing MS. People with RRMS experience defined attacks of new or increasing neurologic symptoms. These attacks are known as “relapses” (or exacerbations). Relapses are followed by periods of recovery called “remission.” During a remission, symptoms may continue and become permanent or disappear. There is no obvious progression of MS during remission.
Secondary progressive
MS (SPMS)
MS (SPMS)
Relapsing-remitting MS can transition to secondary progressive MS (SPMS), a condition in which the disease tends to progress more steadily. Attacks may become less and less common, and people with SPMS can develop steady symptoms over time. SPMS is said to be "active" when someone is still experiencing attacks and "non-relapsing" if attacks do not occur.
Stages of MS progression
MS can affect everyone differently, so it can be hard to tell when MS starts and how it will progress before symptoms start.
Experts think about MS in terms of different stages or phases of progression to better define where you are in your MS journey. These phases include "high-risk," “relapsing-remitting," and "progressive" stages. These stages can often overlap with each other.
High-risk phase
Before people develop MS, there is a period where they are at a high risk of developing MS, depending on genetic and environmental factors.
Relapsing-remitting phase
When there is a relapse and worsening of MS symptoms at least one month after clinically isolated syndrome (CIS), MS is said to progress to its relapsing-remitting phase.
At this stage, MS will show up on an MRI.
Progressive phase
MS is in the progressive phase when symptoms have been progressing for at least one year.
In this phase, people can have active disease with or without symptoms, due to an overlap between the relapsing-remitting and progressive phases.
80% of people move to this stage of MS.
How many people have MS?
About
900,000
people in the US are estimated to have MS. MS is also 2–3 times more common in women than in men.
85%
of people with MS are usually diagnosed with RRMS, which can move to a progressive stage over time.
20–49
years
is the most common age range for MS diagnosis. However, diagnosis can also happen at other ages.
How relapsing MS affects
the body
Relapsing MS is thought to be an autoimmune disease, which means that instead of defending the body against harmful invaders (such as viruses or bacteria), the immune system attacks the body itself.
healthy nerve
Damaged nerve
In relapsing MS, immune cells attack nerve cells of the brain called neurons. These neurons have nerve fibers (axons) that are protected and insulated by the myelin sheath. Myelin helps neurons send electrical signals to and from the brain, telling the body what to do.
With relapsing MS, immune cells cross the blood-brain barrier (BBB), cause inflammation within the central nervous system (CNS), and attack the myelin sheath. This is thought to interfere with the ability of neurons to send signals between the brain and the body.
When your brain can't properly communicate with nerves and muscles, various symptoms of relapsing MS can occur. MS can cause cognitive issues, such as problems concentrating, issues multitasking, or learning difficulties. Some early MS symptoms also include fatigue, muscle weakness, spasms, and tingling and numbness in different parts of the body.
Even infrequent or mild relapses can cause permanent damage to the CNS. If you feel you might be having a relapse, be sure to talk to your healthcare provider as soon as possible.
Get more details about MS and the immune system.
Differences between MS relapses, flare-ups, and pseudo-relapses
"Relapse," "flare-up," and "pseudo-relapse" are similar terms you may frequently hear when it comes to the worsening of MS symptoms.
In MS, these terms are used interchangeably. For a sudden worsening of symptoms and the appearance of new symptoms to be considered a true MS relapse, these symptoms must:
- Last for more than 24 hours
- Occur at least 30 days after the last relapse
Relapses, also known as flare-ups or exacerbations, are new symptoms or a worsening of existing symptoms. These symptoms can include numbness, tingling, vision loss, double vision, vertigo and trouble walking, weakness, and mental health problems like depression and anxiety. These can last from days to weeks and are often unpredictable.
A pseudo-relapse is a temporary worsening of existing MS symptoms. Unlike a true relapse, it is not caused by new inflammation in the brain and spinal cord. It is usually triggered by factors like infection, stress and heat that can temporarily worsen symptoms. Pseudo-relapses usually resolve within 24 hours when the trigger has been addressed.
Relapsing MS causes brain lesions that can be detected by MRI
Relapsing MS causes brain lesions that can be visualized with magnetic resonance imaging (MRI). MRIs are able to show both recent lesion development and previous lesion damage. Some common types of lesions that can be visualized with MRIs include:
Gd+ enhancing lesions:
A dye containing gadolinium is used to show lesions that indicate active inflammation
T2 lesions:
T2 lesions show the long-term impact of inflammation on the brain
T1 lesions:
T1 lesions show damage that may be permanent
The exact relationship between MRI findings and the development of clinical symptoms is not clear. However, MRIs are commonly used to help you and your healthcare provider monitor disease activity in your body.
It’s important to talk with your neurologist about each one of your MRIs because that may help with working out a treatment plan.
Finding the right relapsing MS treatment option for you
Whether or not you are experiencing any relapsing MS symptoms that you can feel on a daily basis, underlying relapsing MS activity could be damaging your CNS.
Studies have shown that nerve damage, which may contribute to physical disability progression, can happen during relapses or when new symptoms arise.
Starting on treatment as soon as you're diagnosed can help slow this progression, so be sure to talk with your healthcare provider. Look into how different treatment options work, their clinical studies, side effects, effectiveness, and their dosing and administration. Learning all you can about MS and the treatment options out there can empower you to make a confident decision with your healthcare provider.
How to prevent MS relapses?
You can’t prevent an MS relapse, but working with your healthcare provider, here are some steps you can take that may lower the rate and severity of relapses:
- Treating MS with disease-modifying therapies (DMTs), which can help reduce relapses
- Avoiding common triggers, such as stress, infections, and hot weather
- Implementing lifestyle changes, such as not smoking, exercising regularly, eating a balanced diet, and getting adequate sleep
- Having a full-body check-up at least once a year and talking with your healthcare provider about any changes to your health
How long does it take to
recover from MS relapses?
recover from MS relapses?
Recovery time from MS relapses varies with treatment, but significant improvements are usually expected in the first 2–3 months, with continued improvement possible over the course of a year.
Everyone with MS is different. Some people recover from their relapses, while others have lasting symptoms that don’t go away. Your healthcare provider can keep an eye on the progress of your MS and help you choose the right treatment option.
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