More than two-thirds of the approximately 1 million people with multiple sclerosis (MS) in the United States have relapsing-remitting MS (RRMS), which means they have periods when their symptoms are severe — relapses — and periods when their symptoms are less severe, although they may not disappear completely. Some people with secondary-progressive MS, a later stage of RRMS, continue to have relapses, along with a general progression of symptoms and disability.

Is It a Flare or a Pseudo exacerbation?

The periods when new symptoms appear or old ones reappear or get worse are called MS flares, or, alternatively, relapses, attacks, or exacerbations. Flares occur because of inflammation in the central nervous system — the brain and spinal cord — causing damage to the myelin or underlying nerve fibers.

To be considered a true flare, a relapse must occur at least 30 days after the previous flare, and the new or recurring symptoms must last for at least 24 hours.

When new or worsened MS symptoms clear up in less than 24 hours, it’s called a pseudo-relapse or pseudo exacerbation. Heat, stress, fatigue, and infections are often behind pseudo exacerbations.

While the symptoms of a pseudo exacerbation are real, there is no new damage being done in the central nervous system.

True flares typically come on over several hours to several days and can last anywhere from a few days to a few weeks.

It is not always clear from the outset whether a person is experiencing a flare or a pseudo exacerbation, and sometimes watching and waiting is the only way to know.  But if you experience any new symptom that interferes with your ability to function normally, says Matthew McCoyd, MD, a neurologist at Loyola University Medical Center in Chicago, let your doctor know about it right away.

Symptoms of a Flare

The signs and symptoms of an impending MS flare include virtually any of the possible symptoms caused by MS. They vary from person to person and from flare to flare.

Many people begin to recognize certain symptoms that signal that a flare may be coming. “As unpredictable as the disease is, my signs are pretty regular,” says Cathy Chester, a writer who lives in New Jersey with her husband and son and was first diagnosed with relapsing-remitting MS in 1986.

“My feet and sometimes my fingers start tingling, and I begin to feel weak; those are usually the first signs that something is awry,” says Chester. For Chester, numbness and extra fatigue often follow those initial symptoms. “I know at that point that my body is warning me that a flare or a pseudo exacerbation is coming,” she says.

Other possible signs of an oncoming relapse include:

  • Increased fatigue
  • Tingling or numbness anywhere on the body
  • Brain fog, or difficulty thinking
  • Muscle spasms
  • Depression
  • Visual changes, such as blurring or double vision
  • Pain
  • Tremors
  • Severe balance problems
  • Severe weakness
  • Dizziness
  • Bladder changes
  • Any combination of these symptoms

Getting to know how MS usually affects you, and monitoring how you feel from day to day, can help you catch potential flares early. At the same time, being overly vigilant can have a negative effect on your mental health.

It’s best — although not easy — to find a way to strike a balance between noticing what’s happening in your body and worrying about every change or sensation.

“When I was first diagnosed, I worried a lot more when I started to get these signals, partly because everything was new,” says Chester. Now that she’s more knowledgeable about living with MS, she adds, it’s become easier to notice symptoms or changes in her body and not overreact or get stressed about them.

It’s also important to consider other possible causes of your symptoms; they may have nothing to do with MS, but they may still need to be checked out by a medical professional. To read this article in its entirety click the link: How to Spot the Signs of an MS Flare.