Managing MS Relapses
Relapse and Exacerbation
This information can be found on the National Institute for Health and Care Excellence (NICE) guidelines. It aims to improve the quality of life for people with multiple sclerosis by promoting prompt and effective symptom management and relapse treatment, and comprehensive reviews.
A relapse in multiple sclerosis (MS) is when a person with MS experiences a sudden worsening of existing symptoms or the appearance of new symptoms. Relapses are sometimes called episodes, attacks, or exacerbations.
Recognising a relapse
Consider a relapse of MS if the person:
- develops new neurological symptoms or
- has worsening of existing symptoms
- and these last for more than 24 hours in the absence of infection or any other cause after a stable period of at least 1 month.
When considering a relapse of MS:
- rule out infection – particularly urinary tract and respiratory infections and
- rule out other causes for symptoms and
- discriminate between the relapse and fluctuations in disease or progression.
- Ensure that the MS multidisciplinary team is told that the person is having a relapse, because relapse frequency may influence which disease-modifying therapies are chosen and whether they need to be changed.
Treating acute relapse of MS
Non‑specialists should discuss a person’s diagnosis of relapse with a healthcare professional with expertise in MS.
Consider treatment for relapses of MS that affect the person’s ability to perform their usual tasks.
Develop local guidance and pathways for timely treatment of relapses of MS. Ensure follow up is included in the guidance and pathway.
1.7.1
Diagnose a relapse of MS if the person:
- develops new symptoms or
- has worsening of existing symptoms
and these last for more than 24 hours in the absence of infection or any other cause after a stable period of at least 1 month. [2014]
1.7.2
- rule out infection – particularly urinary tract and respiratory infections and
- discriminate between the relapse and fluctuations in disease or progression. [2014]
1.7.3
Do not routinely diagnose a relapse of MS if symptoms are present for more than 3 months. [2014]
1.7.4
1.7.5
1.7.6
1.7.7
1.7.8
Consider intravenous methylprednisolone 1 g daily for 3 to 5 days as an alternative for people with MS:
- in whom oral steroids have failed or not been tolerated or
- who need admitting to hospital for a severe relapse or monitoring of medical or psychological conditions such as diabetes or depression. [2014]
1.7.9
1.7.10
Information about steroid treatment for MS relapse
Not all relapses require steroid treatment, follow local guidelines or seek advice from your local specialist neurology service.
For people being treated with steroids, discuss the benefits and risks, taking into account the effect of the relapse on the person’s ability to perform their usual tasks and their wellbeing.
Explain the potential complications of high‑dose steroids, for example temporary effects on mental health (such as insomnia, depression, confusion and agitation) and worsening of blood glucose control in people with diabetes.
Medical, therapy and social care needs at time of relapse or exacerbation
Identify whether the person having a relapse of MS or their family members or carers have social care needs and if so refer them to relevant social services for assessment.
Consider inpatient treatment to the person having a relapse of MS if their relapse is severe or if it is difficult to meet their medical and social care needs at home.
Identify whether the person with MS having a relapse or exacerbation needs additional symptom management, rehabilitation or multidisciplinary input and refer as indicated.
1.7.15
Identify whether the person having a relapse of MS or their family members or carers have social care needs and if so refer them to social services for assessment. [2014]
1.7.16
Offer inpatient treatment to the person having a relapse of MS if their relapse is severe or if it is difficult to meet their medical and social care needs at home. [2014]
1.7.17
Explain that a relapse of MS may have short‑term effects on cognitive function. [2014]
1.7.18
Identify whether the person with MS having a relapse or exacerbation needs additional symptom management, rehabilitation or consideration for disease-modifying treatments. [2014 amended 2022]
Common Relapse Symptoms
Symptoms during a relapse vary, but may include:
- Muscle weakness, spasms, or stiffness
- Numbness or painful sensations
- Vision changes (such as blurred or double vision)
- Difficulty with balance or walking
- Fatigue
- Memory or concentration problems
We believe that evidence-based information, positive attitudes, and lifestyle modifications can have a profound effect on symptom management and long-term health outcomes.
What Should You Do If You Suspect a Relapse?
If you think you are experiencing a relapse:
- Contact your GP or MS Nurse, even if you do not feel you need immediate treatment. This helps track your MS activity and guides future treatment decisions.
- If you cannot reach your usual health providers and are concerned, visit your local emergency department
Managing a Relapse
Not all relapses require treatment. Many improve on their own.
Steroids
If symptoms are severe or disabling, a short course of high-dose steroids may be prescribed to speed recovery. Steroids do not affect the long-term outcome of MS or the degree of recovery from a relapse.
Disease Modifying Treatments (DMTs)
Discuss with your neurologist whether you are eligible for DMTs, which can reduce the frequency, severity, and progression of relapses
Rehabilitation
Physiotherapy and other rehabilitation services may help restore function after a relapse.
Rest & Exercise
Fatigue is common during a relapse. Rest is often recommended, but gentle exercise may aid recovery-discuss with your healthcare team what is appropriate for you