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Managing Relapses

Understand the definition and cause of MS relapses (exacerbations) and learn about medications and rehabilitation strategies to manage them.


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An exacerbation of MS (also known as a relapse, attack or flare-up) is the occurrence of 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. No two exacerbations are alike.  Symptoms vary from person to person and from one exacerbation to another. For example, the exacerbation might be an episode of optic neuritis (caused by inflammation of the optic nerve that impairs vision), or problems with balance or severe fatigue. Some relapses produce only one symptom (related to inflammation in a single area of the central nervous system). Other relapses cause two or more symptoms at the same time (related to inflammation in more than one area of the central nervous system).

To be a true exacerbation, the attack must last at least 24 hours and be separated from the previous attack by at least 30 days. It must also occur in the absence of infection, or other cause. Most exacerbations last from a few days to several weeks or even months.

What causes exacerbations?

Exacerbations (relapses) are caused by inflammation in the central nervous system (CNS). The inflammation damages the myelin, slowing or disrupting the transmission of nerve impulses and causing the symptoms of MS.

In the most common disease course in MS — called relapsing-remitting MS — clearly defined acute exacerbations are followed by remissions as the inflammatory process gradually comes to an end. Going into remission doesn’t necessarily mean that the symptoms disappear totally — some people will return to feeling exactly as they did before the exacerbation began, while others may find themselves left with some ongoing symptoms.

Treating exacerbations

The good news is that not all exacerbations require treatment. Mild sensory changes (numbness, pins-and-needle sensations) or bursts of fatigue that don’t significantly impact a person’s activities can generally be left to get better on their own.

For severe exacerbations (involving loss of vision, severe weakness or poor balance, for example) which interfere with a person’s mobility, safety or overall ability to function, most neurologists recommend a short course of high-dose corticosteroids to reduce the inflammation and bring the relapse to an end more quickly. The most common treatment regimen is a three or five-day course of intravenous (Solu-Medrol® - methylprednisolone) or oral (Deltasone® - prednisone) corticosteroids. Corticosteroids are not believed to have any long-term benefit on the disease.

Other treatment options:

  • H.P. Acthar Gel  is a highly-purified preparation of adrenocorticotropic hormone  (ACTH) in a gel that is designed to provide extended release of the ACTH following injection. It is FDA-approved for the treatment of MS relapses in adults. Its use is limited due to high cost and access issues. It is often considered when someone cannot tolerate glucocorticoids.
  • Plasmapheresis (plasma exchange) may be considered for severe exacerbations that do not respond adequately to the standard steroid treatment.

For more information about these medications, including usage, side effects and precautions, go to the Managing Relapses section of the Medications page


The goal of a rehabilitation program is to restore or maintain functions essential to daily living. Rehabilitation can be especially useful soon after an exacerbation to help you get back on track.

The members of the rehab team — including physical therapists, occupational therapists, speech/language pathologists and cognitive remediation specialists — address problems with mobility, dressing and personal care, role performance at home and work, and overall fitness. They also provide evaluation and treatment of speech and swallowing difficulties and problems with thinking and memory that may have appeared or worsened during the exacerbation.


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