How long do relapse symptoms last?
The most obvious sign of multiple sclerosis is relapses – those attacks of symptoms such as nerve tingling, muscle weakness, vision problems or a host of other problems. Relapses generally indicate a flare-up of inflammation in the brain or spinal cord. Unfortunately, they are just the tip of the iceberg because only about 1 in 10 flare-ups is felt as a relapse. Inflammatory damage is still going on even when you aren’t experiencing any relapse symptoms.
A relapse is defined as new or worsening MS symptoms that persist for a day or two. But the residual effects can last much longer. The severity and intrusiveness of symptoms may lessen somewhat, but they can persist for a month or more. How long they last is an important clue to the state of your MS.
A new study presented at the American Academy of Neurology annual meeting looked at how the duration of relapses affected how well people did over a period of 20 years (Novotna and colleagues. AAN 2014; abstract S34.006). Most people with relapsing-remitting MS fully recovered within three months after the start of a new bout of symptoms. Those who did recover fully were less likely to develop secondary-progressive MS over the short term. In contrast, among those who didn’t recover fully within three months, one-half of them developed secondary-progressive MS over the next 13 years.
These findings suggest two things about relapses. The duration of relapse symptoms is a good measure of how severe the relapse was (i.e. how much damage it was causing). Secondly, people who recover more quickly from a relapse may be able to heal the damage a little bit better (although why some people heal better than others isn’t known).
Some relapse symptoms seem inherently worse than others, but research is a bit mixed about which symptoms are most worrisome. Symptoms affecting more than one functional system (e.g. tingling [sensory] symptoms plus muscle function, or balance plus vision) appear to be worse than symptoms affecting one system (e.g. sensory alone even if it involves multiple symptoms such as tingling plus nerve pain [both sensory]) (Naldi and colleagues. Open Neurol J 2011;5:75-82). If more than one system is involved, it suggests that the inflammation in the brain is more widespread.
Some symptoms – such as bowel/bladder problems or nerve tingling – appear to last longer than others (Leone and colleagues. Mult Scler 2008;14:485-493; Naldi 2011). And some symptoms are just worrisome in themselves, such as losing the ability to coordinate muscle movements (called ataxia), tremor, jumpy vision (called nystagmus) or difficulties with speech or swallowing.
No relapse is benign and all of them should be reported to the neurologist or MS nurse, even if you recover quickly and aren’t left with any residual problems. MS medications are intended to reduce the inflammation in the brain, so ongoing relapses is a pretty good sign that a given treatment isn’t working. So it may be time to think about trying another therapy to get the inflammation under control and limit the amount of damage that’s going on.
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