Multiple Sclerosis Relapse

In brief: A multiple sclerosis relapse is a new episode of inflammatory neurologic dysfunction after a period of stability, assessed in the absence of a better explanation such as fever or infection.

Use in multiple sclerosis

A relapse can cause visual, sensory, motor, brainstem, cerebellar, or spinal symptoms. Conventions commonly require symptoms to last at least 24 hours and to be separated from a prior attack, but clinicians also assess anatomy, severity, objective findings, infection, and other diagnoses.

Heat, fever, infection, exertion, or poor sleep can temporarily worsen prior symptoms without new inflammatory injury; this is often called a pseudo-relapse. Gradual worsening over months may indicate progression rather than an attack. [1]

Selected functionally significant relapses may be treated with high-dose corticosteroids after assessment. Rehabilitation and supportive care can be important during recovery. [2]

Clinical detail

Relapse documentation should record onset, functional system, objective findings, treatment, and recovery. A new MRI lesion can show activity without a recognized relapse, while symptoms can worsen without a new lesion.