Multiple Sclerosis Pathway - Provider Information: Managing Relapse
A relapse or exacerbation is a relatively sudden episode of new symptoms or severe worsening of existing MS symptoms. Relapses are most common earlier in the disease course, but patients can experience a relapse at any time.
Patients experiencing an acute relapse should be assessed by a health care provider in a timely manner. We recommend patients also contact their neurologist or the MS clinic to discuss their relapse. Debilitating relapses can be treated with high dose pulse steroids, ideally within 14 days of onset. Additional symptom management or supports may be required during or after a relapse. Patients may feel significantly worse during a relapse (e.g. fatigue, brain fog, generalized weakness), and may need to be counselled about these symptoms—which will likely improve with relapse remission. It is rare that a relapse is sever enough to require hospitalization.
Suspect a relapse of MS if the patient:
- develops new symptoms or
- has worsening of existing symptoms and these last for more than 24 hours in the absence of infection or any other cause after a stable period of at least 1 month
Before diagnosing a relapse of MS, rule out infection—particularly urinary tract and respiratory infections; symptom worsening in context of infection of major stress would be considered a pseudorelapse, and is managed by treating the underlying issue. It is important to discriminate between the relapse and normal fluctuations or progression in the disease. Do not routinely diagnose a relapse of MS if symptoms have been present for more than 3 months.
Ensure that the MS team members (primary neurologist, primary care provider, nurse educator) are aware of the relapse, because relapse frequency may influence which disease-modifying therapies are chosen and whether they need to be changed. Patients should be encouraged to report all possible relapses to their care team.
The primary neurologist may prescribe or advise primary care providers to prescribe a dose of steroids or other treatment. In general, treating a relapse leads to faster recovery from the relapse, but does not affect the magnitude of recovery or long term disease outcomes.