Relapses
A relapse is a new or worsening neurological symptom that lasts at least 24 hours, occurs at least 30 days after any previous episode, and isn’t triggered by heat or infection. It’s also called an episode, attack, exacerbation, or flare-up.
In relapsing MS, these episodes bring sudden onset of new symptoms or a sharp worsening of existing ones. Progressive MS, by contrast, follows a gradual decline without defined relapses.
Most people recover to their pre-relapse baseline, though some relapses leave lasting damage. Relapses vary in intensity and duration (days to months), and even mild ones can damage nerves—so report any new or worsening symptoms to your medical team promptly.
What is MS?
Key Information
- Duration: Relapses can develop over hours or days and last a few days to several weeks or even months. Most commonly, symptoms persist for several weeks before improving.
- Symptoms: Typical relapse symptoms include weakness, unsteadiness, bladder or bowel disturbances, double vision, numbness, or clumsiness.
- Other explanations: Sometimes, symptoms can worsen temporarily due to factors like infections, fever, or stress. This is not a true relapse, and treating the underlying cause (such as an infection) usually resolves the symptoms.
Concerned about a relapse?
If you suspect you are having a relapse, work your way though the “Recognising a Relapse” steps and contact your MS Community Advisor, GP or MS nurse.
Reporting your symptoms helps your health team track your MS activity and make decisions about your treatment.
If you concerned about sudden and alarming symptoms which are of an urgent need call 111.
Recognising a Relapse
There are several aspects to consider when identifying a new relapse
New or worsening symptom: If you experience the onset of new symptoms or significant exacerbation of symptoms, you have previously experienced, in the absence of infection it could be indicative of a relapse. These symptoms might include numbness or tingling in limbs, muscle weakness, fatigue, difficulty with coordination or balance, visual disturbances, bladder or bowel changes, or problems with cognition.
Duration and persistence: A relapse typically lasts for at least 24 hours and persists for several days or even weeks. If your symptoms persist or worsen over this duration, consult with your healthcare provider.
Functional Impact: Assess how the symptoms affect your daily life and activities. If they significantly interfere with your ability to perform routine tasks or impact your overall well-being, it’s important to consider the possibility of a relapse and report it to your healthcare provider.
Rule out other causes: Can you rule out other factors that could mimic or contribute to your symptoms, such as infections, side effects from medication, temperature changes, increased stress, fatigue, menstruation, menopause, or other medical conditions. It’s essential to consult with your healthcare provider to determine the underlying cause of your symptoms.
Temperature changes: Uhthoff’s phenomenon or pseudo-exacerbation is the worsening of neurologic symptoms when the body is overheated. This may occur due to hot weather, exercise, fever, saunas, hot tubs, hot baths and hot food and drink.
Be prepared
It can often be a confusing time, identifying whether you are having a relapse, and knowing when to seek advice or urgent care. Discuss early with your MS Nurse or Neurologist how they would like you to report any relapses you may experience.
The “Recognising a Relapse” card is a useful tool to keep to hand, checking whether what you are experiencing might be a relapse, and what actions you should take. You can download or request a copy from Multiple Sclerosis NZ or your local MS Society.
Acknowledgement: This handy card was developed by Fiona d’Young, MS Nurse & colleagues at Auckland Te Whatu Ora
Seeking help
Reach out to your healthcare team, including your GP, neurologist, or MS nurse, to discuss your symptoms and any changes you have noticed. They will evaluate your condition and determine if a relapse is occurring.
Remember, the diagnosis and management of relapses should be overseen by healthcare professionals familiar with your medical history and experienced in managing MS.
It’s crucial to maintain open communication with your healthcare team to ensure proper evaluation and appropriate treatment, if necessary.
Even if you think you don’t require any change in medication, alerting your healthcare provider to your potential relapse helps to build up a picture of how active your MS is.
Managing a relapse
Your health team will assess your symptoms to determine if you are experiencing a relapse. Not all relapses require treatment. If symptoms are mild, they may improve on their own.
If symptoms are severe, you may be offered a short course of high-dose steroids to help speed up recovery. Steroids can help your relapse pass quicker, but don’t affect your overall level of recovery.
There are other treatments and lifestyle modifications that can help you when you’re having a relapse.
After a relapse
- Recovery: Most people recover to their previous level of function after a relapse, although some may experience lasting changes if the relapse is severe or affects certain areas of the brain or spinal cord.
- Ongoing self-monitoring: Keeping a record of your relapses and discussing them with your health team is important for managing your MS and making decisions about disease-modifying therapies.
Taking control
Disease Modifying Therapies (DMTs): There are several DMT options funded in NZ for relapsing MS. These treatments designed to reduce the frequency of relapses and slow the progression of new areas of inflammation (lesions). Where possible, DMTs are the best line of defence against relapses.
There may be other treatments and lifestyle modifications that can help you when you’re having a relapse. You should discuss your options with your Neurologist, MS Nurse or GP.
Rehabilitation: While it may not be possible to improve all lost function, people with MS can reduce the impact of the disease by optimising their physical, mental, and social well-being. Rehabilitation can help improve quality of life, particularly after a flare up of symptoms.
During remission periods people with MS should participate in a maintenance therapy programme to re-achieve and maintain good physical and mental health. Depending on symptoms, this may involve physiotherapy, stretching, coordination exercises, speech, and swallowing instruction. It may also include medication, good nutrition, counselling, and lifestyle changes (both social and occupational).
Lifestyle Modifications: While Relapses are not entirely preventable, implementing positive lifestyle modification can help to ensure your brain and body is able to manage and recover.
