6 Tips for Dealing with Multiple Sclerosis Relapses

Multiple sclerosis is a neurodegenerative disease for which there's still no curative treatment. Flares and relapses are challenges that require a particular approach.

Written and verified by the doctor Maryel Alvarado Nieto.

Last update: 20 November, 2022

Multiple sclerosis relapses occur when there’s a re-appearance of neurological dysfunction symptoms that last more than 24 hours. This also includes the worsening of the patient’s clinical manifestations in the last month.

However, these symptoms shouldn’t be caused by fever, hormonal or metabolic changes, or sleep disturbances. These situations worsen the condition of MS patients, but can’t be considered as multiple sclerosis relapses.

At present, the origin of multiple sclerosis is unknown. Scientific literature recognizes two overlapping pathological phases:

1. On the one hand, there’s an autoimmune inflammatory process that degenerates the myelin sheath of the white matter in the central nervous system (CNS). This mechanism is responsible for the symptoms of the outbreaks.
2. Likewise, a progressive degeneration of axons and neurons also occurs, leading to permanent disability, typical of the advanced stages of the disease.

Pharmacological management of multiple sclerosis relapses includes the administration of glucocorticoids, especially methylprednisolone, at high doses. Such therapy has been shown to be extremely useful in shortening the duration of exacerbations and decreasing their intensity.

However, steroids don’t seem to modify disease progression. Their adverse effects limit their use in patients with mild flare-ups.

Tips to deal with multiple sclerosis relapses

1. Continuous medical evaluation

Although it seems an obvious recommendation, not all patients with multiple sclerosis attend their periodic medical check-ups. This hinders the timely monitoring of both symptoms and neurological lesions visible on imaging studies.

The lack of a close follow-up results in delays in the recognition of multiple sclerosis relapses. For this same reason, there’s a delay in the establishment of treatment.

It’s considered that, in one year, an average of 0.5 flares occur in the early stages of the disease.

Because of this, experts recommend medical evaluations every six months and MRI checks at least once a year. It’s important to highlight that, even though steroids can’t treat the disease, their early use could have a protective effect by decreasing the inflammatory process.

2. Knowledge is fundamental in relapses of multiple sclerosis

Knowledge of the disease on the part of the patient is vital for them to cope with his or her pathology. To this end, it isn’t only necessary to provide accurate information during your doctor’s appointment, but it’s also recommended for patients to attend informational sessions.

The purpose of these meetings is to increase the sufferer’s understanding of MS. Continuing education promotes behavioral change, which improves the patient’s perspective on his or her condition.

Similarly, enriching knowledge about the disease has the potential to reduce relapses in multiple sclerosis, in comparison with those who didn’t receive this service. However, there’s still little documentation on this, and more research needs to be done.

3. Control the potential triggers

About 10% of the infections that occur in MS patients will lead to relapse. For this reason, it’s imperative to prevent them, especially those that are a risk factor for these patients.

Vitamin C allows acidification of urine in people with incomplete bladder emptying. It’s a prophylactic measure with certain effectiveness against colonization by some bacteria.

Similarly, respiratory tract infections and gastrointestinal tract infections should be prevented in patients with difficulty in ambulation and voiding dysfunctions. These measures should be controlled by a trained professional.

It’s important to emphasize that when symptoms suggest there’s an infectious process, a physician should be consulted immediately for a timely assessment. On the other hand, conditions such as increased environmental temperature, intense exercise, hormonal changes, stress, and lack of sleep, all exacerbate the symptoms of MS.

Although these don’t constitute an outbreak as such, they do worsen the manifestations. They should, therefore, be avoided.

4. Rehabilitation

Symptoms in multiple sclerosis depend on the injured area in the central nervous system. Because these areas have different locations, there’s a wide range of possible physical manifestations.

However, the most common signs are as follows:

• Motor disturbances
• Visual disturbances
• Proprioceptive symptoms

The evaluation of each symptom and its intensity should be carried out by a group of specialists. This is to ensure that the pharmacological options to treat them are as accurate as possible.

The literature proposes some general advice that can help the patient to cope with the relapse of multiple sclerosis. However, these shouldn’t replace the pharmacological approach. Among the recommendations are the following:

• Wear loose clothing made of natural fibers
• Take breaks periodically during the day
• Perform physical exercise on a regular basis
• Stay in cool or air-conditioned environments
• Plan most activities in the morning hours
• Use mechanical support devices
• Eliminate smoking
• Decrease salt intake

5. Dietary supplements

Vitamin D deficiency has been proposed as a risk factor for MS, but not all MS patients have low vitamin D levels. Therefore, for some, it’s good to consider correcting the deficiency. The choice of dosage has been a matter of debate among researchers and there’s no consensus on this issue.

On the other hand, the incorporation of oily fish, such as salmon, into the diet of these patients is advised. If this isn’t possible, supplementation with long-chain fatty acids (omega-3) is considered safe for them.

6. Treat the hidden symptoms of multiple sclerosis relapses

There are three clinical manifestations that are considered hidden symptoms of MS:

• Fatigue
• Depression
• Cognitive impairment

Despite their high prevalence, neuropsychological rehabilitation isn’t usually offered as an initial therapeutic option in these patients. However, there are great improvements in healthy behavior in people with MS when such interventions are used.

Cognitive behavioral therapy (CBT) and, more recently, mindfulness training, have been shown to be effective strategies in the management of the stress this disease causes. In fact, one study corroborated a decrease in the number of new injuries in those patients who received individual CBT training.

However, these effects disappeared at the end of the therapy.

The advantage of mindfulness over CBT is that the positive impact of the practice can be maintained over time, even if you don’t continue the process. The skills acquired can be implemented on an individual basis, thus giving an improvement over time.