Recognizing Pseudo Exacerbations in MS

Debi Wilson avatar

by Debi Wilson |

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My readers have recently brought something to my attention: They informed me that not all MS exacerbations (flare-ups, relapses, and attacks) are created equal. I have learned that along with the hardcore types, which usually require steroid treatment, there are also pseudo-exacerbations.

I can always trace the causes of my debilitating flare-ups: typically triggers such as urinary tract infections, viral infections, or heat. Doctors have told me these flare-ups were exacerbations but I hadn’t heard of a pseudo-exacerbation until a couple of my readers contacted me. They pointed out that it is essential to differentiate between the two types, that not all exacerbations led to myelin damage, and that knowing the difference alleviates anxiety about disease progression with each attack.

I have relied on the National Multiple Sclerosis Society’s description of exacerbations. Its website states that: “An exacerbation of MS (also known as a relapse, attack, or flare-up) causes new symptoms or the worsening of old symptoms. It can be very mild, or severe enough to interfere with a person’s ability to function at home and work. No two exacerbations are alike, and symptoms vary from person to person and from one exacerbation to another.”

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That definition is broad whereas an article on MS Focus Magazine provides a clear comparison between the two: new lesions on the brain or spinal cord cause true exacerbations, while pseudo-exacerbations are triggered by external factors including infections, stress, and increases in body temperature and are not related to new lesions.

One way you can tell the difference is that a true exacerbation lasts over 24 hours and occurs at least 30 days after the last attack, whereas a pseudo-exacerbation usually resolves within 24 hours. You should contact your doctor for an evaluation if you experience a relapse. A true exacerbation may require steroids whereas a pseudo-exacerbation can be treated by eliminating the trigger and rest.

Now that I understand the differences in exacerbations, I realize that some of my previous flare-ups were pseudo-exacerbations. They had external triggers and I didn’t receive a steroid treatment. I am happy to know they were not caused by new lesions and were not related to MS progression.

I am very thankful to the readers who pointed out these differences to me. I am relieved to know that I have not caused my MS to progress by sitting in the sun too long or catching a cold. I appreciate your input, so please keep your comments coming or join this discussion in our forums.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.


Brad Sutton avatar

Brad Sutton

Thanks for sharing.

I wondered if I was having mild flare ups thinking it was possibly ocular-neuritis. Which I was dealing with every couple years. I was having brief boughts of everything being very bright particularly out of one eye. It would settle followed by a headache. My neurologist explained to me given the brief nature of the symptoms it was very likely that I'm getting mild migraines and it isn't related to my MS.

Debi Wilson avatar

Debi Wilson

Yes,it can be difficult to know what is MS related and what isn’t. Thank-you for your comments, Brad! Best to you, Debi

Jennifer Bodurtha avatar

Jennifer Bodurtha

I have had MS for 30 years and have realized, several years ago,that my right eye blurryness was caused by beef. Have been fine ever since I stopped eating beef several years ago. Food allergies can be odd.

Debi Wilson avatar

Debi Wilson

That’s interesting, Jennifer. Thanks for sharing that! Best to you, Debi

Marv Michael avatar

Marv Michael

Dr. Roy Swank wrote a MS diet book that encourages MS patients not to eat Beef or Pork


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