Flare-ups in Multiple Sclerosis

Multiple sclerosis (MS) flare-ups are distinct, sudden episodes of either new symptoms or a worsening of existing symptoms. They are characteristic in  relapsing-remitting MS (RRMS), which is marked by recurrent acute flares (relapses) followed by partial or complete recovery (remission).

Approximately 85 percent of all MS patients are diagnosed initially with RRMS. The remaining 15 percent have what is called primary-progressive MS (PPMS), and undergo a gradual physical decline with no noticeable remissions.

Characteristics of MS flare-ups

A flare-up may consist of one or more symptoms that last for at least 24 hours and up to weeks or months. To be a flare-up symptoms must be specific to MS and not due to other factors, such as an infection. Two distinct flares-ups are separated by a remission period of at least 30 days.

Flare-ups also are known as attacks, relapses, episodes, or exacerbations.

The underlying mechanism of a flare-up is the immune attack on the myelin sheath (outer insulating layer on nerve fibers), which causes slow or interrupted neuronal signals in the brain and spinal cord. This results in flare-up symptoms such as problems with balance, coordination, eyesight, bladder function, memory or concentration, mobility, fatigue, weakness, numbness or needle-like sensations. Remission occurs when acute inflammation decreases.

Flare-ups could be triggered by various factors such as stress, infections, or pregnancy and symptoms may vary from mild to severe.

Managing relapses

Mild symptoms such as fatigue, numbness, and needle-like sensations could be left to subside and may need no treatment.

For severe flare-ups such as vision loss, extreme weakness, and poor balance that interfere with patients’ everyday activities, experts recommend a short-course with high-dose of corticosteroids. These facilitate recovery from a relapse by reducing inflammation, but do not affect the course of the disease. The most common treatment regime is a three-to-five day course of intravenous Solu-Medrol (methylprednisolone). Oral Deltasone (prednisone) also may be used.

Steroid treatment works best if started immediately after the onset of the flare-up. However, steroids have side effects that may include increased appetite, weight gain, high blood pressure, and thinning of bones.

For MS patients who do not tolerate the side effects of high doses of corticosteroids, or who have been treated unsuccessfully with corticosteroids, H.P. Acthar Gel (adrenocorticotropic hormone, ACTH) is used as a second-line therapy. Acthar Gel is administered via under the skin (subcutaneously) or into a muscle self-injection.

Plasmapheresis, a blood-cleansing method to remove the myelin-attacking antibodies from the blood, is another option for treating severe relapses that do not respond to the standard steroid treatment.

Patient rehabilitation aims to restore the essential everyday functions after a relapse. It combines different approaches, including physiotherapy, dietary advice, employment services, and support at home. The rehabilitation team can help the patient with difficulties in swallowing, mobility, dressing, personal care, and office work.

Recovery from a relapse may take weeks or months, with symptoms disappearing partially or completely. 


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.

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