Staying Ahead of MS Attacks

People with multiple sclerosis (MS) often experience a fluctuation in symptoms, with some days being nearly symptom-free. In the relapsing-remitting form of the disease, most people will have a number of good days (or even weeks or months) followed by the sudden onset of new symptoms and/or a worsening of existing MS symptoms. This is known as an MS attack, sometimes referred to as a flare-up, relapse, or exacerbation. 

MS attacks are triggered by inflammation in the central nervous system. Inflammation damages the myelin (the protective coating surrounding your nerve fibers) and disrupts the transmission of nerve signals. The blocked signals do not reach their targets or allow the brain to interpret some signals, leading to MS symptoms.

This article provides information about MS attacks and how to treat them. 

MS Attack Symptoms 

Though approximately 85% of people with MS experience attacks, no two people will experience them in the exact same way. Symptoms can vary each time you have an attack. Sometimes you may have a mild attack, and at other times symptoms may be so severe that they interfere with your quality of life. You may experience only one symptom or several, depending on which areas of the central nervous system are involved. 

Symptoms of MS attacks include: 

• Balance problems
• Bladder issues (such as a loss of bladder control or a frequent need to urinate)
• Dizziness 
• Fatigue
• Memory problems
• Mobility issues
• Numbness or tingling in legs and/or arms
• Trouble concentrating
• Vision problems

Identifying Flare-Ups  

There are a few things to consider in order to identify the onset of symptoms to be an MS attack, including:

• New symptoms appear and/or previous symptoms become worse: Many people with MS experience ongoing symptoms, but they tend to remain stable between attacks. When symptoms change, this may indicate an attack. 
• Symptoms last 24 hours or more: An attack generally lasts longer than a day. 
• Symptoms occur at least 30 days from the start of your last attack: Your MS symptoms must be stable for at least a month before symptoms worsen or new ones appear. 
• No other explanation for the symptoms: Illness, stress, and other factors can be mistaken for an attack. When these factors are ruled out, it may be an MS attack. 

If you’re not sure if you’re experiencing an MS attack, wait a day or two before speaking to your doctor to see if your symptoms improve. Depending on the severity of your symptoms, your doctor may want to see you in person to ensure you don’t have an infection and may make adjustments to your treatment plan. 

How Long They Last 

To qualify as an MS attack, symptoms must last for at least 24 hours. The duration of an attack varies, depending on how severely inflammation has impacted the central nervous system. MS attacks can last anywhere from a few days to several weeks or months.

MS attacks tend to occur most often in the first few years after being diagnosed. However, they can occur at any time throughout the course of the disease. 

MS Attack Triggers

Researchers continue to explore exactly what triggers an MS attack. These factors appear to have a connection to the increased risk of an attack:

• Age: Adults ages 50 and older are at a higher risk of relapse than younger adults. This may be because inflammation in the body tends to increase as we get older, leading to age-related diseases and an increased risk of MS attacks.  
• Hormones: Studies show that relapse is more common in males than females with MS. This may be due to reproductive hormones, which may play a role in the likelihood of an attack and the types of symptoms experienced during an episode. Men tend to experience more severe relapse symptoms related to cognitive function and balance, and women tend to experience more visual and sensory symptoms. 
• Infections: A viral or bacterial infection, such as urinary tract infections (UTIs), pneumonia, and bacterial skin infections, may trigger an MS attack. Researchers estimate that approximately 27% of MS attacks are triggered by an infection in the weeks before the onset of MS symptoms.
• Stress: Experiencing stressful events or chronic stress may trigger an attack. An analysis of 14 studies showed a connection between non-traumatic stressful level events and the occurrence of MS relapses.
• Vitamin D levels: Research shows that people with MS who do not have sufficient levels of vitamin D in their bodies have a higher risk of experiencing an attack. In one study, increasing vitamin D levels reduced the risk of attacks by 42%.

What Helps During MS Relapse 

Self-Care 

MS attacks can be challenging, both physically and emotionally. Self-care is always important, but it’s of particular importance when you are in the middle of or recovering from an attack. You may need to make some adjustments to your day-to-day life in order to allow yourself a chance to fully recover, including by doing the following: 

• Get plenty of rest: Physical activity can be challenging during an MS attack. It may also be harder for you to perform your usual daily tasks. Give yourself plenty of time to rest, and eat a healthy diet rich in nutrients while you recover. 
• Ask for support: It isn’t always easy to ask for help, but reaching out to friends, family members, and others in your community can help you get the emotional and physical support you need to get through an attack. 
• Consider therapy: Living with MS isn’t easy, and many people with the condition experience periods of depression and anxiety. Talking to a mental health professional can help you address your emotional needs and process all you’re going through. 
• Be gentle with yourself: You may feel down in the dumps due to the onset of new or worsening symptoms. Be gentle with yourself and know that you are doing the best you can in frustrating circumstances. Talk to yourself as you would a treasured friend, and be patient as you navigate this difficult time. 

Treatments

Not all MS attacks need to be treated. If new symptoms show up or existing symptoms worsen that don’t impact your quality of life, you may notice they clear up on their own in time. Some attacks can cause more severe symptoms that require treatment, such as loss of vision, severe weakness, or problems with mobility, your doctor may recommend treatment. 

Treatments for MS attacks include: 

• Corticosteroids: The most common treatment for MS attacks is a short course of high-dose corticosteroids to reduce inflammation. These medications may be oral (pills) or administered intravenously (IV). 
• H.P. Acthar Gel: A highly purified form of adrenocorticotropic hormone (ACTH). Given as an extended-release injection, this option is typically used in those who cannot tolerate steroids. 
• Plasmapheresis: Plasma exchange is a treatment option for severe attacks that are not relieved by standard steroid treatments. This is administered in a hospital setting, where antibodies are removed from your blood and replaced with filtered plasma (the yellow, liquid portion of blood).  

In addition to medications, your doctor may recommend rehabilitation to help you regain strength and mobility and address any issues you may have with personal care and performance at work and home. You may see physical therapists, occupational therapists, speech therapists, and/or cognitive remediation specialists. 

When to Go to the Hospital 

If you are experiencing new symptoms, talk to your healthcare provider. They may want to see you in person to address your symptoms and modify your treatment plan. 

If you have severe symptoms, you may need to go to the hospital. Go to the hospital during an MS attack if you:

• Suddenly can’t walk, eat, or use your limbs
• Lose vision in one or both eyes
• Are experiencing intense pain 
• Have a high fever (can indicate infection) 

Summary

MS attacks, often called an MS relapse, flare-up, or exacerbation, are common in the first few years after an MS diagnosis. MS attack symptoms vary widely and include balance problems, vision problems, numbness and tingling, and trouble concentrating. If symptoms are severe, medications such as corticosteroids may be prescribed to reduce inflammation and manage symptoms. 

A Word From Verywell

Going through an MS attack can be a challenging time. Knowing your triggers (such as stress and low vitamin D levels) can help you practice good self-care to reduce the likelihood of new attacks. You may question whether you're actually having a flare-up or if something else is causing this new onset of symptoms. When in doubt, contact your healthcare provider.

While there is no cure for MS, many people with the condition are able to live comfortable and fulfilling lives with support and the right treatments.