Definition of MS relapse
Multiple sclerosis (MS) relapse is defined as a new neurological deficit in any system, with objective findings, Developing acutely or sub-acutely, with a duration of at least 24 hours, with or without recovery, in the absence of fever or infection. Relapses could be associated with Systemic infections, Stress, Postpartum period, and assisted reproductive technique (ART).
Due to the relationship between viral or bacterial infections and relapses, preventive vaccination is reasonable and recommended.
Pseudo-relapse is similar to symptoms in the presence of fever, heat exposure, infection, menstrual period, and stress. Affects the same body part as in the previous relapse, although symptoms may not be as intense. It should be considered when patients report symptoms similar to past MS relapses.
Importance of relapse treatment
Treatment of MS relapses helps to shorten the duration of relapses and lessen the disability. Residual deficits may persist after MS relapse and contribute to the stepwise progression of disability.
Evaluate patients with possible MS relapse within 1 week (or 5 working days) of the onset,
Rule out pseudo-exacerbation; (clinical and laboratory signs of infection, exposure to high temperature).
No need to stop DMDs during relapse treatment.
Good clinical response may be achieved 2-3 weeks after treatment.
Mild MS attack may not require immediate treatment,
Moderate to severe relapses with disabling symptoms should be treated.
Starting treatment as early as possible (within 1 week) is best.
Relapse treatment can be successful as late as 1 to 2 months after relapse.
MRI is not indicated for MS relapse diagnosis, as it is a clinical diagnosis. However, an MRI may be done for a different reason; such as to assess the adequacy of the current disease-modifying therapy. If MS relapse is confirmed, treatment should be started as soon as possible.
The FDA approval for MS relapse is IV methylprednisolone. High-dose steroid treatment was defined as at least 500 mg methylprednisolone or equivalent. As usual, 1 gram per day for 3-5 days is considered. Oral prednisone tapering should be noted on an individual basis. However, some data suggest no additional benefit for oral taper. lack of improvement by 2 weeks as an indication for additional treatment. In patients not respond to initial treatment, especially clinical worsening following first-line treatment, the second line of treatment is followed. Plasma exchange, every other day for up to 5 to 10 exchanges is the best-supported option as second-line therapy.