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Managing Relapses in Multiple Sclerosis
Dr. Sam Hooshmand and host Jon Strum discuss ways to identify and manage MS relapses.
Multiple Sclerosis Relapses
Relapses are caused by attacks of the immune system on the central nervous system. This causes inflammation, which damages the myelin that protects the nerve fibers. This damage slows or disrupts the transmission of nerve impulses, causing the symptoms of MS.The most common form of MS is relapsing-remitting MS (RRMS). In RRMS, remission comes after relapses as the inflammatory process comes to an end. But remission doesn’t necessarily mean the symptoms completely go away. Some people will feel exactly like they did before the relapse. Others may have some ongoing symptoms.
Not all relapses require treatment. If you are experiencing numbness, pins-and-needle sensations or bursts of fatigue that don’t significantly impact your activities, they can generally be left to improve on their own.Severe relapses can cause symptoms such as loss of vision, severe weakness or poor balance. They can interfere with your mobility, safety or overall ability to function. Most neurologists recommend a short course of high-dose corticosteroids (also known as steroids, an anti-inflammatory medication) such as Solu-Medrol® (methylprednisolone) or Deltasone® (prednisone) to reduce the inflammation and end the relapse faster. Corticosteroids are not believed to have any long-term effect on the disease.
H.P. Acthar Gel is an FDA-approved treatment for MS relapses in adults. However, its use is limited due to high cost and access issues. It is often considered when someone cannot tolerate steroids.
Plasmapheresis (plasma exchange) may be considered for severe relapses that do not respond adequately to the standard steroid treatment. Plasmapheresis removes the antibodies that are thought to be active in some autoimmune diseases. Studies have shown that it may be beneficial for people living with MS in this situation.
How plasmapheresis works is:
Whole blood is withdrawn from a large vein
A machine separates the liquid portion of blood (plasma) from the red and white blood cells
The cells are transfused back along with a plasma replacement fluid
Side effects include occasional infection and blood clotting problems. Talk to your healthcare provider to discuss whether plasmapheresis is right for you.
A rehabilitation program aims to restore or maintain functions essential to daily living. Rehabilitation after a relapse can help get you back on track.Some of the challenges rehabilitation can address after a relapse include: