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Understanding and Coping With MS Flares

Here's why multiple sclerosis symptoms flare, along with a few tips to prevent flares.

In MS, the immune system mistakenly attacks the central nervous system (the brain and spinal cord), starting with the myelin sheath, the insulating layer of protein and fat that protects the part of the nerve cell known as the nerve fiber, or axon.

Damage to the myelin and to the underlying axons interrupts or stops the transmission of nerve impulses between the brain and other parts of the body, resulting in the signs and symptoms of MS. Those can include vision loss, balance problems, fatigue, numbness and tingling, and many others, depending on where the damage occurs.

While some MS symptoms can be long-lasting or permanent, in the most common type of MS, called relapsing-remitting MS, other symptoms tend to come and go.

When symptoms reappear, or new symptoms appear, it is called an MS flare or, alternatively, an exacerbation, relapse, or attack.

What Defines an MS Flare?

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

Acute symptom flares are followed by periods of months or even years when symptoms subside or completely disappear.

Symptoms of an MS Flare

Symptoms of MS flares vary from person to person. However, some common symptoms signaling a flare include the following:

  • Severe fatigue
  • Numbness and tingling in the arms and legs
  • Eye pain or blurred vision
  • Weakness
  • Balance difficulties
  • Bladder or bowel problems

According to Tanuja Chitnis, MD, associate professor of neurology and director of the Partners Pediatric MS Center at Massachusetts General Hospital for Children, “Symptoms of an MS flare generally come on over the course of several days."

Causes of a Flare

Flares are caused by inflammation in the central nervous system that damages areas of myelin.

Exactly what triggers the inflammation can be difficult to pinpoint. However, says Dr. Chitnis, "Flares can be triggered by infections, including bladder infections." And, she adds, "Some evidence suggests that stress may trigger flares, but this is still controversial."

One misconception is that vaccines increase the risk of an MS flare.

"The evidence is strong that vaccinations do not trigger flares," Chitnis says.

Preventing MS Flares

Though flares cannot be prevented entirely, it’s sometimes possible to avoid the things that may trigger them. For example, since flares can be triggered by infection, it's important to wash your hands frequently during cold and flu season and to get an annual flu shot, as long as there are no medical reasons not to.

Taking steps to lower your risk of urinary tract infections can help, too. These include:

  • Drinking plenty of water or other fluids to flush out bacteria
  • Urinating when you feel the urge
  • Seeing your doctor for treatment of any ongoing bladder problems, such as urinary incontinence or urinary retention

Some experts also recommend drinking cranberry juice daily to prevent against bladder infections. While this has not been proven to be effective, it likely does no harm, either.

Duration, Severity, and Recovery

Flares can last anywhere from a few days to a few weeks, depending on your response to treatment.

Sometimes a brief flare-up of symptoms can occur and then resolve without any treatment at all. This is called a pseudoexacerbation and is not technically classified as a relapse. Pseudoexacerbations are usually brought on by increased body temperature and go away when the body cools down, sometimes in a matter of minutes.

RELATED: Keeping Your Cool: MS and Heat Intolerance

The severity of flares varies from person to person and from flare to flare. Some research, including a study published in Neurology in 2014, shows that people with higher levels of vitamin D have less severe flares.

Recovery is also variable. Chitnis says that younger people generally recover better from flares than older people.

Poor recovery from flares in the first five years following diagnosis could be a risk factor for developing early secondary progressive MS, according to a study published in August 2015 in Neurology.

Treatment for MS Flares

Mild flares may not require any treatment, but more severe relapses that impact a person’s ability to function can be treated with high-dose steroid medications for several days to shorten the duration of the flare. Steroids reduce inflammation and relieve symptoms, but they do not reverse the damage to the nerves.

Disease-modifying therapies for MS aren't used to treat flares, but some of the newer ones show promise at preventing them, says Bruce Bebo Jr., PhD, executive vice president for research for the National Multiple Sclerosis Society.

“Treatments seem to be getting better at decreasing the frequency of flares and the inflammation responsible for them and the damage the flares cause to the body,” Dr. Bebo says.

Tecfidera (dimethyl fumarate), for example, an oral medication approved in 2014, has been shown to significantly reduce the rate of relapses, according to a study published in the October 2013 issue of Expert Opinion on Pharmacotherapy. Lemtrada (alemtuzumab), a biologic given intravenously and also approved in 2014, can reset the immune system and potentially also decrease flares long-term, Bebo says.

Recovering from an MS Flare

Some people regain total functioning after a flare, while in others, the recovery may be only partial. A variety of types of rehabilitation specialists — including physical therapists, speech language pathologists, occupational therapists, and cognitive specialists — can play an important role in helping you regain physical and mental functioning after a flare.

Additional reporting by Liza N. Burby.

Story Source: The above story is based on materials provided by EVERYDAYHEALTH
Note: Materials may be edited for content and length

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