A multiple sclerosis flare-up occurs when the central nervous system (CNS) becomes inflamed and causes damage to the myelin sheath, which is the protective layer of fatty tissue that covers the nerve cells. This, in turn, disrupts the normal signaling of the nerve cells between the brain and the rest of the body. A relapse or flare-up is defined as a symptom that starts 1 month after the last flare-up and persists for at least 24 hours.
In MS, there are several common triggers that can lead to flare-ups. However, triggers vary from person to person and most of the time, an exact cause cannot be found.
Still, in order to lower your chance of experiencing a flare-up, you should be aware of the most common triggers, which include:
Stress – Stress in everyday life is inevitable but you can lower your chances of a flare-up by doing yoga, meditating, or seeking counseling. One particular study found that after 6 weeks of yoga, MS patients’ stress levels were cut nearly in half.
Fatigue – It is important to make sleep a priority, especially if you have MS. Lack of sleep can trigger a flare-up so try to get a good night’s rest – at least 7-8 hours a night.
Infections – Infections are known to cause over 30% of MS flare-ups. In order to lower your risk, wash your hands thoroughly, avoid being around individuals who are sick, make sure your food is fully cooked, drink plenty of fluids, get your annual flu shot, and practice safe sex.
Diet – It is known that an unhealthy diet can trigger inflammation and more persistent symptoms of MS. For this reason, make sure to eat foods that are rich in omega-3 fatty acids. A well-balanced and healthy diet can keep your immune system strong and able to fight off any infections.
High temperatures – Symptoms of MS include numbness and dizziness, so when you are surrounded by extremely high temperatures such as hot weather or hot baths, this can cause extreme fatigue. It is best if you stay indoors during hot weather and take a cool bath. Even frozen gel packs can help keep you comfortable and cool when dealing with symptoms of MS.
Medications – Skipping any medications that you’re currently taking for your MS can increase your risk of a flare-up by 25%. So, make sure to take your medication as prescribed and in certain cases where you may be experiencing unwanted side-effects, talk with your doctor right away.
Smoking – It has been found that smoking negatively affects the CNS. Since MS is associated with the CNS, smoking is believed to be a major risk factor for MS flare-ups.
MS flare-ups are not always easy to spot, which is why it is vital that you are aware of your symptoms as soon as they occur. Together with your doctor, you should make sure that you are experiencing an actual flare-up, as opposed to a pseudo-relapse. A pseudo-relapse may seem as if you are experiencing a new MS flare-up when in fact, you are not. “Watch for symptoms that last for more than 24 hours,” said Michael Racke, chairman of the neurology department at Ohio State University's Wexner Medical Center in Columbus. For instance, you may be experiencing increased body temperature as a trigger; however, unlike an MS flare-up, a pseudo-flare lasts only as long as the increased body temperature remains -usually less than 24 hours.
During an MS flare-up, you will either experience new symptoms or your current symptoms will worsen. You may experience anything that affects your brain or spinal cord, including dizziness, numbness, tingling, tiredness, weakness, blurry vision, imbalance, and pain. “These flares can last for days to weeks to months and cause damage to the myelin and the nerves themselves,” said Daniel Kantor, neurologist. That's why it is important that you take necessary steps to not only prevent MS flare-ups, but also prepare for them - just in case.
- Stay on top of your health
- Stay hydrated
- Avoid or quit smoking
- Perform relaxation techniques such as meditation or yoga
- Get plenty of rest
- Take your prescribed medications
While your symptoms might disappear on their own, you should let your doctor in on what is going on with your health. “I advise people with MS to have a proactive conversation with their doctor about what to do if they suspect a flare. Will you go in for an urgent office visit? Is an appointment necessary? Should you proceed directly to the emergency room?” said Dr. Kantor. Treating your symptoms can reduce inflammation within your body and shorten your MS flare-ups, thus allowing you to recover much quicker. Make sure your doctor knows about any changes.
Preventing MS flare-ups
“The only thing that’s been proven to prevent an MS flare is to adhere to disease-modifying treatment,” said Dr. Kantor says. Certain anti-inflammatory drugs, such as steroids, can help reduce inflammation and slow down MS progression, thus lowering your chances of experiencing MS flare-ups. The most common steroid prescribed is Methylprednisolone. Still, some individuals with MS may be bothered by the side effects that certain steroids present, including mood changes, difficulty falling asleep, abdominal pain, and weight gain. For such individuals, another option is Acthar gel, also known as ACTH gel. It is injected into the muscle or under the skin and works by triggering your adrenal gland to release hormones that will help reduce inflammation within your body. For extremely severe MS flare-ups that do not seem to improve with steroid therapy, you may want to consider undergoing plasma exchange. This procedure involves retrieving some of your blood, taking out the liquid part known as plasma, replacing it with another substitute plasma liquid, and then injecting it back into your body.
Recovering from a flare-up
After an MS flare-up, it is possible for you to fully recover; however, it might take a few weeks or months for your symptoms to calm down. If you had experienced a lot of nerve damage, some of your symptoms might not fully disappear. In terms of treatment for MS, the type of treatment that is right for you greatly depends on your symptoms, as well as the severity of your MS flare-ups. Your doctor may recommend rehabilitation to help you get your life back on track. Different rehab programs exist including:
- Physical therapy to help improve your movement and keep you active
- Cognitive therapy to help with your thinking problems and improve your memory
- Occupational therapy to help you learn, recover, and maintain certain activities of your personal care in a safer and simpler manner
- Speech-language therapy to help treat your problems with speaking and swallowing
The objective is to help restore and maintain your functionality and your overall quality of life. Even if you do not decide to participate in a rehab program, you should still stay in touch with your MS doctor as you recover. Any questions that you may have should be directed to him or her, discussed ahead of time, and shared with your loved ones so that everyone around you is prepared in case you experience an MS flare-up.