The three stages of RRMS relapses

Relapsing Remitting MS (RRMS) is the most common form of multiple sclerosis, with around 85% of people living with MS diagnosed with this phase of the disease. People who have RRMS experience varying symptoms, going between relapses; the sudden appearance of a new symptom or the reappearance or increase in severity of an existing symptom¹, and periods of remission; a period of time with little to no symptoms². 

No two people experience MS in the same way. However, there are similarities in the patterns of relapses and remissions, with people living with MS experience which usually following three stages:

Before: Recognising a relapse

It can sometimes be difficult to work out whether you are having a relapse or if it's a cluster of bad symptoms¹. Any MS symptom can be a sign of a relapse, but the most common ones can include: fatigue, issues with balance, mobility, eyesight and bladder control, areas of numbness, pins and needles or pain, as well as cognitive problems, such as memory loss and difficulty with concentration. Some relapses can be formed of only one symptom in a single area of the central nervous system, whereas others are made up of multiple symptoms at the same time and can last anywhere between 24 hours to several weeks². 

If you think you're having a relapse, you should report it to your MS team as soon as possible, so they can help you find the best ways to manage it. Relapses have the potential to be a sign that your MS is progressing and therefore it's extremely important to report each one to your MS team and monitor your symptoms³. 

Your MS nurse or doctor may ask you some questions to better understand your relapses, such as the following³: 

• When did your symptoms start to change and what has been the pattern of this change?
• What symptoms are you experiencing?
• Which part of your body is affected, for example, if you have numbness, where is this?
• Have the symptoms stopped you doing anything that you can normally do, such as driving, getting up and down stairs, working, etc.?
• Have you been ill lately or had any symptoms of infection, for example, unexplained shivering?
• What medication are you taking and has your medication or dose changed recently?

For more help preparing for appointments with your MS team, click here. 

During: Treating a relapse 

Not all relapses require treatment – it depends on the symptoms. Symptoms like numbness, tingling or other sensations can generally be left to get better on their own. However, more serious symptoms, such as loss of vision, poor balance and mobility issues, might require medical treatments⁴. The conversations you have with your MS team at the start of a relapse will help guide the best course of treatment. 

Treatments for relapses vary significantly depending on symptoms and can include: medicine, hospitalization, physiotherapy, occupational therapy, neuropsychology or speech and language therapy³. 

After: Recovery 

If you’ve experienced a relapse it's important to remember that they will usually settle down. It is likely that you will feel tired and unwell while recovering, but rehabilitation can be especially useful soon after a relapse to help you get back on track ^{3, 4}. You may find that the relapse might have affected any of the following areas of your life: 

• Home life: Doing daily chores, such as cleaning or walking, can become difficult. It's important to be patient and kind to yourself and keep within your limits. Ask for help from your family and loved ones. If recovery at home is taking longer than usual, reach out to your MS team who can help in finding a carer or MS nurse to support you³.
• Work life: You may find it helpful to reduce your work hours or take some time off. Adjusting your work schedule can help with both your physical and cognitive symptoms. Speak to your manager or HR representative to secure the necessary time you need to aid your recovery. 
• Cognitive function: After a relapse, every aspect of your body is in recovery. Be patient with yourself as you might experience altered emotions, sleeping patterns and memory/ problem-solving issues³. If you think you are experiencing any of these symptoms, reach out to your MS team for support. 

There are many different forms of care and support available to help manage and treat a relapse. The best advice is to speak to your MS team as soon as you think you might be having a relapse and they can tailor the most suitable course of treatment to meet your needs. To find out more about the science behind the relapses, click here. 

 References: 

1. MS Trust. Relapsing remitting MS. Available at: https://www.mstrust.org.uk/a-z/relapsing-remitting-ms-0 Accessed August 2020.
2. Web MD. Relapsing-Remitting Multiple Sclerosis. Available at: https://www.webmd.com/multiple-sclerosis/relapsing-remitting-multiple-sclerosis Accessed August 2020. 
3. MS Trust. Managing relapses. Available at: https://www.mstrust.org.uk/about-ms/ms-symptoms/managing-relapses#what-is-a-relapse Accessed August 2020
4. National MS Society. Managing relapses. Available at: https://www.nationalmssociety.org/Treating-MS/Managing-Relapses Accessed August 2020.