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Two of the same cells are fighting each other. One is being used as a punching bag and the string of myelin holding on is falling apart.

Inside An MS Exacerbation

Exacerbation, relapse, flare-up, attack: these are all names for the same thing with regard to Multiple Sclerosis. The general definition of this event is the occurrence of new or worsening of old symptoms lasting for more than 24 hours and taking place at least 30 days after a similar event. While this can be standard occurence for those with Multiple Sclerosis, not everyone actually understands what’s going during this period. Understanding what is happening during an exacerbation is critical for those with MS. With that in mind, I’ll do my best to help break it down as simply as I can.

What’s happening to the body during an MS exacerbation?

During one of these moments, the disease has caused your own immune system to attack your body. Specifically, your immune system begins to assault your central nervous system. Its weapon of choice? Inflammation (caused by various immune cells). This inflammation damages myelin, a fatty substance that surrounds and helps insulate our nerves. This insulative layer makes sure our nerves properly conduct the electrical signals that our brain sends to the other parts of our body (think of it as the plastic covering on an electrical wire). When this layer is damaged, those signals don’t move fast enough or at all, which is where we start to see our symptoms. Can’t lift your leg fast enough or at all? The myelin around a nerve between your brain and leg has been compromised and the signal isn’t traveling as efficiently as it should be. Not only does our immune system damage the myelin, but it also damages the cells needed to regrow it.

When the immune system attacks

These moments that we call exacerbations (or whichever term you like) are when the immune system is making its attack. It’s when the immune system has created a lot of inflammation in your central nervous system, and it’s damaging that myelin layer. Not only does this inflammation damage that protective coating, but it also has an effect on those signals that are traveling through that part of the central nervous system. We use steroids to fight exacerbations as they help to reduce this inflammation.

When a relapse is over: the aftermath

When an exacerbation is over, these damaged areas of myelin develop some scar tissue (that’s where we get the term sclerosis in multiple sclerosis, we are left with multiple scars; these scars are also referred to as plaques or lesions). Once all that inflammation is gone or significantly reduced, some of that myelin can regrow, but it never grows back completely or strong enough due to the scarring and because the cells needed to facilitate regrowth have been damaged. This regrowth, coupled with the reduction in inflammation, is why people can seem to bounce back after an exacerbation. They may even seem like they are completely well again. That’s why people often use the term “relapse,” because they seem to improve or go back to the way they were. This is a pattern that is extremely common in people diagnosed with the Relapsing-Remitting form of the disease. However, the more exacerbations you have, the more your ability to bounce back becomes hindered.

Accumulating damage over time

The more scars you have and the more cells that help regrow myelin are damaged, the less you are able to recover. In the past, maybe a damaged nerve could still get the brain’s signal where it needed to go, even if not the most efficiently (unless an outside influence temporarily triggered an issue). As more damage occurs over time though, the ability of that nerve to do its job, no matter the situation, becomes compromised. Basically, that’s how people with MS can worsen over time. That’s why doctors try to not only shorten the length of exacerbations through steroids, but to minimize the overall number of them with disease-modifying drugs.

Thanks so much for reading and always feel free to share!

Devin

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • GGolden
    2 months ago

    I’m new here, my mother has MS. When she is having a relapse should I take her to the hospital?? Or is there anything I can do to help??

  • Devin Garlit moderator author
    2 months ago

    Hi @GGolden, the best course of action is to contact her MS specialist and see what they think. Many times they will order a course of steroids.

  • Sarasshore
    2 months ago

    I’m trying to get over my first BAD relapse at the moment. I spent almost 4 weeks in the hospital and now I’ve been in a specialized nursing/rehab facility because also for the first time since diagnosis, I’m living alone. Think I’d have been able to be discharged directly from the hospital a couple weeks ago had insurance not kicked me out of the acute rehab there and into this place. I think the stresses I’ve had dealing with the nursing staff and personal issues that put me into a position of homelessness since I’ve been in the nursing/rehab facility have extended my inflammation/relapse. I’d start to feel stronger, something with a specific nurse or my landlord would happen and I’d notice a physical set back. That all my stressors are over, 3 was a few ago so I believe I’m done, I hope so, not sure I can take much more.

  • Devin Garlit moderator author
    2 months ago

    Thank you @Sarasshore! Sorry to hear of your situation. Stress can have a pretty negative effect on our health and no doubt has assisted with some of your setbacks. I hope that things turn around for you soon.

  • Brooks3
    2 months ago

    The neurologists I have encountered where I live are clowns

  • Devin Garlit moderator author
    2 months ago

    Thank you @Brooks3, unfortunately, it’s a lot like that it many places. Find a good doctor is difficult, but critical. I hope you keep up the search!

  • Shelby Comito moderator
    2 months ago

    Ugh how awful @brooks3. It’s beyond frustrating when you don’t have the confidence and care deserve in your own healthcare providers. I thought I’d share the Doctor Finder tool on the MS Society’s website in case it’s helpful in providing you with other options nearby – https://www.nationalmssociety.org/Resources-Support/Find-Doctors-Resources We’re thinking of you and hope you’ll continue to keep us posted on how you’re doing. – Shelby, MultipleSclerosis.net Team Member

  • dgerbing
    2 months ago

    I had a relapse about 1 year ago. It set me back 2 weeks in bed. Dr would not see me. Pain was horrible. The pain stuck around for several months . And no Dr help. Anyway. It came back cannot move shoulders. Why is it the Dr say u just have to live with it? No help ever

  • Devin Garlit moderator author
    2 months ago

    Thank you @dgerbing, it sounds like you really need a different doctor. I encourage you to seek out a new one, it’s not an easy process, but it’s so important to see, second, third, fourth, or even more opinions.

  • chong61
    3 months ago

    I have been awake with leg muscles drawing and hurting these past 2 nights. The pain is very strong, thus I don’t call the condition as my legs being restless, I call them major pain.

    Your writing puts it all in perspective, which is a lot more than our docs do or seem to be capable of doing. Thanks again.

    Arvilla

  • Devin Garlit moderator author
    2 months ago

    Thanks so much @Arvilla, I appreciate that and hope you find some relief soon.

  • Yoshitail9
    3 months ago

    Hey Devin
    Another worthy article. I pay attention to what you write.
    Just one thing. Up above under your heading “When a relapse is over: the aftermath”…… Isn’t a relapse when you have new symptoms versus when you improve or go back to the way you were (remission)? Thanks

  • Tess
    3 months ago

    Awesome!

  • Tess
    3 months ago

    Devin, that was a wonderful explanation. Thank you. Going to write to you on FB.

  • Devin Garlit moderator author
    2 months ago

    Thank you @Tess!

  • lhalvor
    3 months ago

    Excellent read for newbies.

  • Devin Garlit moderator author
    3 months ago

    Thank you @lhalvor!

  • todd
    3 months ago

    Great article! I am on a study drug from Biogen called anti-lingo that hopes to get us to start reproducing myelin.

    Fingers crossed

    Great work Devin

  • Sarasshore
    2 months ago

    Please let us know how the drug affects you and if it gets approved for the rest of us.

  • Devin Garlit moderator author
    3 months ago

    That you @todd, best of luck!

  • MSTony
    3 months ago

    I read the Blog. Very good. Keep them coming. My friend.

  • Devin Garlit moderator author
    3 months ago

    Thank you @MSTony!

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