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Terms & Conditions

 

Multiple Sclerosis

It is important to remember that MS is only one part of a person and not the person.

MS does not represent them, it is not their identity, they are as normal as the next person.  

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Relapse                                                                                                                                                                                                        

The return of signs and symptoms of a disease after a patient has enjoyed a remission. A period in which a person with MS experiences an acute worsening of function that lasts for at least 24 hours, usually lasting for several days or weeks, followed by an improvement that may continue for at least one month.

 

A relapse is a clinically significant event - it has outward signs and / or symptoms - caused by an MS lesion on the brain or spinal cord. It is either a worsening of symptoms already experienced, or the appearance of new symptoms.

 

Acute worsening of function - can mean the development of completely new symptoms or previous symptoms coming back. Examples of this might be double vision or numbness and tingling in a leg without any other obvious cause. To be classed as a relapse, these new or recurrent symptoms must then wear off or improve over time. Once this improvement in symptoms has lasted for at least one month, it is known as 'recovery' or 'remission'.

 

Relapses are also sometimes referred to as ‘attacks’, ‘flares’, ‘incidents’, or ‘episodes’.

 

People may experience a short term worsening of symptoms lasting for a few minutes, hours or even days, which is not due to a relapse, it can be difficult to determine what is a fluctuation in symptoms and what is a relapse. An increase in body temperature due to an infection or following exercise may cause a fluctuation.

 

If you are unsure whether you are having a relapse or experiencing a fluctuation, discuss this with your MS nurse or neurologist.

 

Relapses are categorised as:

• Mild
• Moderate
• Severe

A mild relapse may not require medical intervention, whereas a moderate and severe relapse may.

                                                                                                                                                                                                   

• Avoid extreme heat.
• Eat healthily.
• Rest.
• Manage stress as much as is possible.

 

Medication                                                                                                                                                                                                   

Steroids - Corticosteroids - are a standard treatment for a relapse in MS and have been in use since the mid 20th century.

 

It is unclear exactly how steroids work, they possibly  act by partly suppressing the immune system and / or by reducing fluid accumulation around the site of nerve damage. Studies have shown that steroids are effective in speeding up recovery from relapse but make no difference either to the degree of recovery or to the long-term progression of the condition.

 

Treatment may be in hospital or at home and the drug given orally or intravenously. It has been demonstrated that combining steroids therapy with planned multidisciplinary team care is superior to administering drug therapy alone. [1] [2]

 

Side effects may occur                                                                                                                                                                              

Short-term side effects of steroids are usually, but not always, minor and transient.

 

Long-term treatment side effects include:

• Acne.
• Cataracts.
• Deterioration of the head of the thigh bone.
• Diabetes.  
• Osteoporosis - thinning of the bones.
• Weight gain.
• Long term use may cease to be effective in the treatment of MS.

 

Eligibility for disease modifying drugs based on relapses UK                                                                                                            

Guidelines of the Association of British Neurologists (ABN) say that the person's history of relapses should be confirmed by neurological examination by a specialist or from another source:

• Hospital.
• General Practitioner's records.
• The main caregiver + the person's own experience.

 

NICE Guideline states that individuals should be offered a course of high dose steroids to be started as soon as possible after the onset of the relapse and recommends that courses of steroids be limited to a maximum of three times a year.

 

Exacerbation                                                                                                                                                                                               

An action that makes a problem or a disease (or its symptoms) worse. Not to be confused with relapses. An exacerbation may be the appearance of a new sign or symptom or a worsening of signs and symptoms. Unlike a relapse an exacerbation of MS signs and symptoms will end up with them worse than before.

Remission - Disappearance of the signs and symptoms of the disease. When this occurs, the disease is said to be "in remission”. Sometimes there is a full recovery of all functions after a relapse, but often a person is left with some residual problems. Remission does not mean remission from the disease itself, it refers to the relapse you were experiencing.

Signs - May be Vision problems, weakness, speech problems, swallowing difficulties, compromised reflex reactions etc. Evidence of the disease a clinician may observe on examination of the person.

Symptoms - May include fatigue, spasms, tremor, bladder dysfunction, vertigo etc. Physical manifestations experienced by the person indicating that something is wrong that may not be apparent to the clinician on examination..

 

1. Barnes D. Use of steroids in the treatment of relapse.In: Thompson A, McDonald I. Key advances in the efficient management of multiple sclerosis. London:Royal Society of Medicine Press;1999.

2. Craig J, et al. A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment. Journal of Neurology Neurosurgery and Psychiatry  2003;74(9):1225-1230.

 

Other web sites                                                                                                                                                                                          

Association of British Neurologists theabn.org

 

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