MS flare-ups: Understanding and managing them
### Common Triggers for Multiple Sclerosis (MS) Exacerbations
Infections, particularly viral and bacterial, are the most common triggers for MS exacerbations, according to recent studies. Upper respiratory tract infections (URTIs) and urinary tract infections (UTIs) are frequent culprits, with an increased risk of exacerbations within a few weeks before and after the onset of infection.
Viruses such as Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and other herpesviruses are implicated in MS exacerbations, with EBV having a strong association with both the onset and worsening of the condition. Bacteria and other pathogens like *Mycoplasma pneumoniae*, *Chlamydia pneumoniae*, *Staphylococcus aureus* superantigens, certain protozoa, and fungal infections may also contribute to MS flare-ups.
Environmental and genetic factors, such as low vitamin D levels, smoking, excess body weight in early life, and living in northern latitudes, are associated with MS risk and potentially with exacerbations.
### Effects on Different Types of MS
In relapsing-remitting MS (RRMS), infections serve as key triggers for acute relapses, causing new or worsening neurological symptoms. These relapses tend to be more severe and prolonged when triggered by infection.
Primary progressive MS (PPMS) is less likely to have distinct relapses, but exacerbations can occur occasionally, and infections may worsen symptom progression more subtly but relentlessly.
Secondary progressive MS (SPMS) follows RRMS and is marked by a gradual worsening of disability with or without relapses. Infectious triggers can still provoke relapses during this stage, but the disease progression becomes more continuous over time.
Sleep disturbances or lack of sleep may potentially trigger a relapse in people with MS. It is not definitively known whether vaccinations worsen the symptoms of MS, but concerns exist about live vaccines like the shingles or yellow fever vaccines. The exact cause of MS exacerbations is unknown, but a link between high levels of inflammation and structural changes in the brain has been identified.
People with MS may experience exacerbations in the first 3 months after childbirth, with up to half of people experiencing this. Stress may potentially trigger MS exacerbations, although this has not been conclusively proven. Exacerbations can last from days to several months, although the latter is rare. Low levels of vitamin D can contribute to the risk of MS exacerbations.
During an exacerbation, a person might need treatment for specific symptoms such as vision changes and muscle weakness. Treatment options may include high doses of steroids, plasmapheresis, physical rehabilitation, counseling, and long-term medications known as disease-modifying therapies. Recognising an exacerbation is important, as prompt treatment can help reduce its impact on a person's ability to function in daily life.
Lifestyle measures such as following a heart-healthy diet, managing stress, consulting a healthcare team about an exercise plan, and quitting smoking can help improve comfort and quality of life during an exacerbation. Medical cannabis may also be recommended for treating some symptoms of MS-related pain and muscle problems, according to the American Academy of Neurology.
[1] Freedman MS, et al. Neurology. 2019;92(7):e673-e687. [2] Hauser SL, et al. Mult Scler. 2015;21(13):1529-1537. [3] Kutzelnigg A, et al. Neurology. 2016;86(15):1523-1531. [4] Weinshenker BG, et al. Lancet Neurol. 2004;3(12):817-826.
- Multiple sclerosis (MS) exacerbations are often triggered by infections, such as viral and bacterial, with a strong association between Epstein-Barr virus (EBV) and the onset and worsening of the condition.
- In relapsing-remitting MS (RRMS), a type of MS, infections serve as key triggers for acute relapses, causing new or worsening neurological symptoms, which can be more severe and prolonged when triggered by infection.
- Multiple sclerosis exacerbations can also be influenced by environmental and genetic factors like low vitamin D levels, smoking, and living in northern latitudes, which are associated with MS risk and potentially with exacerbations.
- In the medical-conditions field, multiple sclerosis is considered one of the neurological disorders, and several traters have established different treatment options for managing exacerbations, such as high doses of steroids, plasmapheresis, physical rehabilitation, and counseling.
- In the health-and-wellness sphere, lifestyle measures like following a heart-healthy diet, managing stress, quitting smoking, and consulting a healthcare team about an exercise plan can help improve comfort and quality of life during an MS exacerbation, while medical-cannabis may also be recommended for treating some symptoms of MS-related pain and muscle problems.
