SPINMS.CA | MS & Relapses
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MS & Relapses

MS & Relapses

A relapse is the appearance of a new MS symptom or a worsening of old symptoms that last at least 24 hours without fever and active infection. Relapses are also called exacerbations, flare-ups or attacks. They are a result of an area of inflammation in the brain and/or spinal cord.

Identifying a relapse

You should suspect a relapse if you agree with all of the statements about your symptoms:


  1. There is evidence of new symptoms or worsening of existing symptoms.
  2. The symptoms have lasted continuously for more than 24 hours.
  3. The symptoms have not gone away at all since they started.
  4. There is no evidence of a fever or infection.

Relapse symptoms

Although each person with MS will experience different symptoms, the most common types of relapse symptoms include:


  1. Physical or mental fatigue—almost always associated with another symptom in this list
  2. Numbness or a tingling sensation
  3. Weakness
  4. Vision problems
  5. Increased loss of balance
  6. Changes in bladder and bowel function

What is a relapse?


A flare-up of new symptoms or worsening of old symptoms. If you think you may be experiencing a relapse, refer to the Patient Relapse Decision Guide.


When do relapses occur?


Relapses are unpredictable. They can occur suddenly or progress over days to weeks. If you are not sure, you can always call your health care provider to help you decide.


How long do relapses last?


A relapse last at least 24 hours for new symptoms (48 hours for old symptoms). It is separated from a previous relapse by ≥30 days. They can last days to months.


How are relapses treated?


Generally, they resolve without treatment. For severe relapses, treatment with steroids may be prescribed.

Common symptoms of a relapse.

Increase in fatigue





Visual Problems

Tic Douloureux

Bladder dysfunction

Bowel Dysfunction

Vertigo / dizziness

Trouble walking

Poor coordination

Heavy legs (like wearing cement shoes)




Influenza, Hepatitis B, Varicella and tetanus vaccines do not increase the risk of having a relapse.



Pregnancy and relapses


Relapses are less common during pregnancy, especially in the 3rd trimester

Relapse rates tend to increase during the three months after delivery, but most mothers do not have relapses

Breast-feeding does not appear to affect relapse rate

When MS Attacks: How to Manage Relapses

When you Need to Treat a Relapse

Painful or disabling relapses that interfere with daily activities can be treated with steroids:

Intravenous Methylprednisolone (Solu-medrol ®) and/or oral Prednisone are most commonly prescibed

Solu-medrol ® is given at a dose of 500-1000mg for 3-5 days

An additional oral tapering dose of Prednisone is sometimes given but this is less common


Common side effects

Water retention (increase blood pressure) Headaches

High blood glucose levels Palpitations

Upset stomach Insomnia

Increased appetite Metallic taste in mouth


Less Common Side Effects:

Mood swings Increased risk of infection

Allergic reactions Irregular menses

Acne Reversible memory impairment

Hiccups Ulcers

Rare but possible steroid induced psychosis


Long-term side effects:

High blood pressure Osteoporosis

Hardening of arteries Blood sugar problems



Before using steroids, tell your doctor if you have:


Heart Problems

High blood pressure

If pregnant, consult your doctor and steroids can be prescribed after 12 weeks of pregnancy if needed

To help manage relapses take a look at the Patient Symptom Diary and the Patient Relapse Decision Guide.


PDF Document | 4 Pages | 2 MB


Talk to your neurologist or MS nurse about relapses

Questions you should think about regarding relapses:

  1. When should I call my neurologist or MS nurse?

Call your neurologist or nurse if your symptoms bother you or if they last for more than 24 hours. Your neurologist or MS nurse can determine if you are experiencing a relapse and give you medication to ease the symptoms, or if you need to come in for an assessment.

  1. How are relapses treated?

Relapses can be treated with steroids, but your neurologist may prescribe other medications.

  1. Should I continue my MS treatment?

This can be discussed and assessed by your neurologist on a case by case basis depending on the severity and the number of relapses experienced during your MS treatment.