Relapse vs. Pseudo-Relapse

Relapse vs. pseudo-relapse in multiple sclerosis

MS symptoms can reappear, fluctuate, or even newly develop for a variety of reasons. They do not always indicate an MS relapse or disease progression. Sometimes symptoms occur as a result of some other body stressor, such as a urinary tract infection. This is called a pseudo-lapse.

If you experience new or worsening symptoms that last more than 24 hours, notify your healthcare team to help determine the source of your symptoms and whether any further action is needed.

A pseudo-relapse is a temporary onset of worsening neurologic symptoms without clinical progression of MS that is associated to some other stressor.

Once the initiating cause is treated, the symptoms should resolve.

In both an MS relapse and a pseudo-relapse, symptoms must be present for at least 24 hours.

Pseudo-relapse

With a pseudo-relapse, fever, infections, overheating or overexertion, physical and mental stress, and depression can all lead to a short-term increase in symptoms, which may include fatigue, pain, tingling, and changes in vision, strength, or mobility.

The term pseudo-relapse does not mean the symptoms are fake or made up. It means there is a cause for the symptoms other than disease progression that needs attention from your healthcare team.

Relapse

In contrast, with an MS relapse, the neurological changes are not a result of an internal or external stressor, but MS disease activity evidenced by a new area of inflammation or demyelination present on MRI.

Pseudo-relapse

By treating the root cause of the pseudo-relapse, the symptoms will resolve.

A urinary tract infection (UTI) is an example of a cause for a pseudo-relapse. Once the UTI is treated, the symptoms will improve and return to your baseline level.

Relapse

When treating an MS relapse, the goal is to reduce inflammation in the central nervous system (CNS) to reduce the neurologic symptoms. This is done with either steroids or a few non-steroidal therapies.

There are several factors which determine when and how you and your provider decide to treat an MS relapse. Deciding factors include the type and degree of neurologic symptoms, other health conditions, prescribed medications, and physical access to healthcare.

Steroids are either prescribed as an intravenous (IV) infusion or as oral pills over several days, although some people do not tolerate steroid therapy and require an alternative. Non-steroidal options include adrenocorticotropic hormone (ACTH) injections, immunoglobulin therapy, and plasma exchange.

Relapse vs. Pseudo-Relapse