Relapses and the Progression of MS

One of the biggest challenges of living with multiple sclerosis (MS) is coping with the changing state of the disease. You may encounter periods of severe symptoms followed by periods of remission. Knowing what to expect, how to manage relapses, and how to cope with the overall progression of the disease can help you have the best quality of life with MS.

If you’ve been diagnosed with MS or if a doctor thinks you might be developing MS, here’s what you need to know to live with the disease more effectively.

What a relapse is and why it occurs

The National Multiple Sclerosis Society defines a relapse as an episode that occurs at least 30 days apart from another attack. It lasts at least 24 hours, but it can run for days, weeks, or months.

A relapse of MS is when your immune system attacks the myelin surrounding your nerves in the brain and spinal cord. This attack disrupts the signals in the central nervous system, causing weakness or numbness. The lesions, or areas of damage, can be seen on magnetic resonance imaging (MRI).

A relapse may make existing symptoms worse or cause entirely new symptoms. In many cases, these relapses occur without warning and with a quick onset of symptoms.

How relapses affect you

Depending on the type of MS you have and your unique situation, relapses may occur regularly or they may occur months or years apart. Ongoing relapses typically lead to worsened MS. Studies show that people who have even one relapse during the first two years of MS are at greater risk of more rapid progression of the disease.

That said, it’s important to develop a treatment and therapy strategy and to revisit it from time to time. Doctors often use a tool called the Expanded Disability Status Scale (EDSS) to measure the physical disability associated with MS. This scale is complex and somewhat difficult to use, but it provides insights into where you are in the progression of MS.

Preventing and treating relapses

One of the most effective ways to combat MS is to use medications that help slow or control the progression of the disease. Over the last two decades, researchers have developed several medications specifically designed for MS. These drugs reduce immune response and inflammation. They include:

  • teriflunomide (Aubagio)
  • interferon beta-1a (Avonex, Rebif)
  • interferon beta-1b (Betaseron, Extavia)
  • glatiramer acetate (Copaxone)
  • fingolimod (Gilenya)
  • natalizumab (Tysabri)
  • mitoxantrone (Novantrone)

Doctors also prescribe high-dose corticosteroids such as methylprednisolone for three to seven days. These drugs work on the immune system to shorten the exacerbation and speed up recovery.

Like all drugs, drugs for MS have side effects. These effects could be serious if the drugs are taken long term or repeatedly.

Other approaches

In January 2011, the American Academy of Neurology issued new guideline recommendations that promote the use of plasma exchange to treat patients with severe MS relapses. The guidelines recommend that doctors consider using plasma exchange as a secondary treatment for severe flares in relapsing MS.


During a remission, some symptoms of MS may remain. The National Multiple Sclerosis Society defines a remission as a return to the baseline prior to the start of the last relapse. However, relapses may cause permanent damage or impediments, even after a lesion is no longer active. In fact, studies show that residual impairment is fairly common following a relapse. Upwards of 40 percent of people with MS see some deterioration after a relapse. So, it’s crucial to manage and control MS from the initial diagnosis and prevent attacks whenever possible.

Participate actively

One of the best ways to ensure that you maximize your quality of life with MS is to monitor and manage your disease actively. Here are a few steps you can take:

  1. Become MS literate. Read current research and try to understand advancements in treatments and medications.
  2. Monitor changes in the frequency and severity of your relapses and episodes. This can help you and your doctor determine how your MS is advancing.
  3. Engage in an open, honest, and ongoing discussion with your doctor to understand when new or additional therapies may be helpful.
  4. Participate in support and discussion groups. Learn new information and share your thoughts and ideas about how to cope better with MS.