When Symptoms Arent Due To A Relapse
Not all flare-ups mean that your disease is progressing. For example, a pseudoexacerbation, or pseudo-relapse, is the temporary worsening of symptoms caused by external factors.
Most often, these are caused by an increase in core body temperature due to heat from hot weather, exertion, or fever, known as the Uhthoffs phenomenon. Once your body temperature returns to normal, the neurological symptoms subside. Infections and physical or emotional stress are also common causes of pseudo exacerbations.
The same applies to paroxysmal symptoms of MS. These are the symptoms that appear suddenly, last for a few seconds or minutes, and then disappear just as quickly. Paroxysmal symptoms may occur as a one-off event or repeat in cycles over the course of hours or days. In some cases, the recurrent symptoms may take months to fully resolve.
But even recurrent symptoms like these dont constitute a relapse. They dont so much occur because of a progression of the disease but rather because of the existing nerve injury.
The Stress Of Living With Ms
Living with MS means that you may have to face health limitations, such as problems with mobility, bladder issues, and impaired vision, which can cause frustration and stress. But there are many other concerns those with MS face that factor into the stress of living with this disease as well:
- The unpredictable nature of MS
- Adapting to new symptoms
- Concerns about your job
How Can I Tell If I Have Stress
Medically speaking, stress causes changes in your blood pressure, heart rate and metabolism. You may not notice these changes yourself. In the short-term, these responses can improve your physical and mental performance to cope with immediate crises – the ‘fight or flight’ response. However, left unchecked, excessive stress can have negative effects on physical and emotional health, including a direct effect on levels of fatigue.
Everybody reacts differently to stress, but there are common symptoms:
- Physical – increased levels of sweating, muscle tightness, regular headaches, constipation or diarrhoea.
- Emotional – irritability, reduced concentration, feeling overwhelmed, problems making decisions, decreased confidence, low mood.
- Behavioural – difficulty sleeping, changes in appetite, loss of libido, increased drinking or smoking and reduced willingness to socialise.
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What Triggers Autoimmune Diseases
The most common explanation is that an affected persons immune system, partly due to the genes they inherited, is primed to react abnormally to some trigger, such as an infection, an environmental exposure , or some other factor. For most autoimmune diseases, we cant easily figure out what triggers them. If we could, we might be able to prevent them.
Can Anxiety Worsen Existing Ms Symptoms
Anxiety can often be linked with stress and to depression, a common symptom of MS.
Similar psychological symptoms between anxiety and MS include:
Be unable to concentrate or make decisions
Being on edge, restless or irritable
As well as your mental wellbeing, anxiety can also manifest with physical symptoms, which may be similar to some MS symptoms, such as:
Increase in fatigue symptoms
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Can Stress Make My Ms Worse
Numerous studies over the years have looked at whether stress can trigger an MS relapse. A decade ago, a meta-analysis of 14 studies found that there was an increased risk of having a relapse following a stressful life event . The effect was small, but the authors noted that the harmful impact of stress on relapses was actually greater than the beneficial effect of interferon-beta on relapses. A subsequent meta-analysis agreed that stress can worsen MS, but found it was a little difficult to be definitive because of the way the studies were done .
Different studies may measure different kinds of stress so it isnt clear if certain types of stressors cause more problems than others. At the extreme end is the stress of war. During the war between Israel and Lebanon in 2006, Israelis with MS experienced an increase in relapses . The people who were worse off were those who reported the highest level of stress. That is, the perceived threat appears to be as important as the physical threat itself. Another observation was that people felt the stress more acutely when they were having a relapse compared to when they were in remission, presumably because they felt more physically vulnerable.
So the stress-relapse relationship works both ways. Stress worsens MS, but MS also worsens your feelings of stress.
So what did they find when all of this slicing and dicing was done?
In Part 2 well look at what can be done about stress.
How To Address Ms
Depression, together with anxiety, may worsen thoughts of suicide and shouldnt be left untreated. In most cases, it can be effectively managed with a combination of antidepressants and cognitive behavioral therapy. This type of therapy focuses on identifying and shifting thoughts, beliefs and behaviors that may contribute to emotional distress.
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How The Program Can Help
Good news: although its simply not possible to avoid stressful life events, there are ways that you can learn to deal with stress so that you can prevent MS relapses. Scientists have discovered that stress management techniques can significantly reduce lesions and MS relapses. MS symptoms can also be stressful in themselves and symptoms can naturally feel worse if you are feeling stressed and anxious, so stress management will also help you day-to-day.
Some of the ways in which you can manage stress effectively include:
The OMS program combines all of these factors with the added support of a community.
1. Gold SM, Mohr DC, Huitinga I, et al. The role of stress-response systems for the pathogenesis and progression of MS. Trends Immunol 2005
2. Lalive PH, Burkhard PR, Chofflon M. TNF-alpha and psychologically stressful events in healthy subjects: potential relevance for multiple sclerosis relapse. Behav Neurosci 2002 116:1093-1097
3. Ackerman KD, Stover A, Heyman R, et al. Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity. Brain Behav Immun 2003 17:141-151
4. Mohr DC, Goodkin DE, Bacchetti P, et al. Psychological stress and the subsequent appearance of new brain MRI lesions in MS. Neurology 2000 55:55-61
5. Mohr DC, Goodkin DE, Nelson S, et al. Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med 2002 64:803-809
Is It Common For People With Multiple Sclerosis To Experience Depression
Depression is very common in people with multiple sclerosis . In fact, symptoms of depression severe enough to require medical intervention affect up to half of all people with MS at some point during their illness.
Depression may be the result of a difficult situation or stress. It is easy to understand how having MS, with its potential for progressing to permanent disability, can bring on depression.
Depression might be actually caused by MS. MS may affect the insulating myelin that surrounds nerves which transmit signals affecting mood.
Depression is also a side effect of some drugs used to treat MS, such as steroids or interferon.
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What Is A Relapse
For many people with MS, relapses are a big part of their condition. Here we discuss what relapses are, how to recognise if you’re having a relapse and how to deal with them.
A relapse is a relatively sudden episode of new symptoms or a worsening of existing MS symptoms. People call relapses by different names including an attack, a flare up, an episode, a blip or an exacerbation.
If you have relapsing remitting MS, you may have episodes of symptoms that occur for a period of time which then improve either partially or completely . They tend to happen most often in the first few years after being diagnosed with MS but people can experience a relapse at any time.
If you have secondary progressive or primary progressive MS, you may also experience relapses, but much less frequently.
To be considered a new MS relapse:
If you’re not sure whether you are having a relapse, you could wait a day or two to see if your symptoms improve before contacting a health professional. With time, you will become an expert on your own MS and will develop a better feel for whether you’re having a relapse or it’s just the day-to-day fluctuation of your symptoms.
Whatever symptoms you experience, they’re likely to get gradually worse over a few days, or perhaps longer, and then level off. After a time the symptoms will usually subside and you’ll gradually start to recover. Sometimes the symptoms of a relapse go away completely but, in other cases, they may not fully disappear.
Pushing Yourself Too Hard
Fatigue is a common symptom of MS. If you have MS and constantly push yourself to go without sleep or overexert yourself physically or mentally, you may experience consequences. Exertion and fatigue can trigger a relapse or make flares last longer.
How to avoid: Take it easy on yourself and listen to your bodys cues. Slow down when youre feeling tired. Rest as long as you have to. Pushing yourself to the point of exhaustion will only make recovery more difficult.
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Tests To Diagnose Ms Include:
- Neurological examination this involves testing the cranial nerves to detect possible areas of damage from MS lesions, looking at your reflexes, your muscle strength, the feel of sensations and your vision. You may also have your walking speed and style assessed as part of this physical examination.
- Blood tests mainly to rule out other causes of your symptoms.
- Magnetic resonance imaging to look for scarring in your brain and spinal cord.
- Lumbar puncture to test your cerebrospinal fluid . CFS examination can support MRI findings and help rule out other diseases.
- Neurophysiology tests to measure the electrical activity of the brain to detect possible lesions which may not be seen on an MRI. Tests such as evoked potentials follow impulses as they pass through nerves and can be assessed on your eyes, your ears or your peripheral nerves.
If lesions or scarring are found on the brain or spine MRI, to confirm a diagnosis of MS a neurologist will look for evidence that the scarring happened at different points in time and in different parts of your central nervous system . This forms the basis of international guidelines to help neurologists diagnose MS accurately, called the McDonald criteria.
To achieve the best possible outcomes for people with MS, it is recommended that delays in diagnosing MS be minimised and that goals for treatment and ongoing management of MS be set early in the course of the disease.
Can Myelin Be Regenerated
When myelin becomes damaged, messages find it harder to get through or can‘t get through at all causing the symptoms of MS. Our brains have a natural ability to regenerate myelin. This repair involves special myelin-making cells in the brain called oligodendrocytes. … But as we age, this regeneration happens less.
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What Do Relapses Indicate
No evidence of disease activity is an emerging goal of MS treatment. Breakthrough flares can be an indication that a person’s disease is becoming more active. A breakthrough flare may indicate that its time to consider starting or switching to a new MS treatment. But not all relapses mean a treatment regimen has stopped working.
Drug therapies for MS need time to take effect. If somebody just started treatment maybe a month ago and they had a relapse, it’s possible that that treatment just hasn’t had enough time to get into the system and have its full effect, explained Dr. Nicholas. With each disease-modifying therapy, for the most part, they take about six months to give their full benefit.
The good news is that there are multiple treatment options available to prevent new relapses and new lesions in MS. Typically, we would pick something that we believe, in our experience and based on clinical trials, is more effective than the one that the individual had a breakthrough on, said Dr. Nicholas.
Take the quiz: Is My MS Progressing?
Ms And The Risk Of Ptsd
While the incidence and prevalence of PTSD are about the same whether you have MS or not, chronic illnesses are among the known triggers of PTSD.
Being diagnosed with MS is considered a traumatic event and it is among the many types of trauma that can cause a person to develop PTSD.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines a traumatic event as a situation where you have experienced, witnessed, or have been confronted with an event where there was the threat of or actual death or serious injury. The event may also have involved a threat to your physical well-being or the physical well-being of another person.
Without a doubt, MS meets these criteria. It has a major impact on a person’s body and life. Further, because the symptoms of MS, their severity, and their progression vary from person to person, you may experience a sense of helplessness and hopelessness at the time of diagnosis, as well as at any time throughout your disease course.
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Avoid These Potential Relapse Triggers
When you have relapsing-remitting multiple sclerosis , months of symptom-free bliss can be ruined by a sudden and often unexplained relapse of symptoms pain, fatigue, weakness, problems with balance, and more. There is no clear cause of MS or definite triggers for its symptoms, which makes general recommendations on how to prevent the disease impossible, says Le Hua, MD, an MS specialist at the Cleveland Clinics Lou Ruvo Center for Brain Health in Las Vegas, Nevada.
What triggers a relapse varies widely from person to person. Relapse can also occur for no apparent reason, just by the nature of the disease,” she says. That being said, avoiding some potential triggers whenever possible may help you prevent a relapse.
Ms Inflammation And Stress
Autoimmunity, in which the body’s immune system attacks the myelin around the nerves on the brain and spinal cord, is a component of MS.
Some research suggests that early stages of this inflammation may cause changes in the brain’s function that produce a state of anxiety. Put another way, physiological changes that result from MS can give birth to feelings of stress all on their own, which can compound stress experienced because of external factors, like daily challenges.
Stress has long been associated with MS exacerbations. It isn’t completely clear whether stress actually causes exacerbations, or whether you may become more anxious than usual because of the physical changes that occur before an exacerbation has its peak impact.
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Depression In Ms: A Symptom Or A Reaction
It is easy to assume that people with a chronic illness like MS will inevitably become depressed, says Beier. This incorrect assumption relies on the idea that depression is a reaction to MS. While this is possible, recent research has discovered that depression may also be a symptom.
For persons with relapsing-remitting MS , early in the disease, depression appears to be linked to inflammatory processes. Later, in the secondary-progressive phase, unhelpful thoughts, such as feelings of guilt, worthlessness or hopelessness are more frequent. So the depression in this case is thought to be more reactive linked to frustrations with lifestyle changes or loss of function, explains Beier.
What Is An Ms Relapse
An MS relapse is caused by acute inflammation in the central nervous system damaging the protective myelin. As a result, new MS symptoms occur or old symptoms worsen, but to be defined as a relapse they must be separated from the previous flare-up by at least 30 days and last for at least 24 hours. There must also be no other explanation for the symptoms for example fever, acute infection or acute stress in such cases the new symptoms would be classified as a pseudo-relapse.
Symptoms will vary from person to person and can range from mild sensory disturbance to severe new disability. For example, in some cases it can be just one symptom while others may experience several new symptoms at the same time.
MS relapses can last from several days, to weeks or even months. In relapsing-remitting MS, exacerbations are followed by remissions. Some people will find that they go back to how they were feeling before the exacerbation but going into remission doesnt mean that symptoms always disappear.
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Distinguishing Pseudobulbar Affect From Other Conditions
Pseudobulbar affect can sometimes be confused with conditions such as depression, mood swings and bipolar disorder. The inappropriate outbursts of emotion can also be a source of embarrassment and anxiety.
Its important to have this condition properly diagnosed because, unlike depression or anxiety, it cant be treated with talk therapy or counseling. Certain antidepressants or a specially manufactured drug targeting a certain chemical in your nervous system can be used to treat pseudobulbar affect.
What Is Multiple Sclerosis
Multiple sclerosis is an autoimmune disease. With these conditions, your immune system mistakenly attacks healthy cells. In people with MS, the immune system attacks cells in the myelin, the protective sheath that surrounds nerves in the brain and spinal cord.
Damage to the myelin sheath interrupts nerve signals from your brain to other parts of your body. The damage can lead to symptoms affecting your brain, spinal cord and eyes.
There are four types of multiple sclerosis:
- Clinically isolated syndrome : When someone has a first episode of MS symptoms, healthcare providers often categorize it as CIS. Not everyone who has CIS goes on to develop multiple sclerosis.
- Relapsing-remitting MS : This is the most common form of multiple sclerosis. People with RRMS have flare-ups — also called relapse or exacerbation — of new or worsening symptoms. Periods of remission follow .
- Primary progressive MS : People diagnosed with PPMS have symptoms that slowly and gradually worsen without any periods of relapse or remission.
- Secondary progressive MS : In many cases, people originally diagnosed with RRMS eventually progress to SPMS. With secondary-progressive multiple sclerosis, you continue to accumulate nerve damage. Your symptoms progressively worsen. While you may still experience some relapses or flares , you no longer have periods of remission afterward .
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