This article discusses acute exacerbations (relapses) of multiple sclerosis (MS). Relapses are a hallmark of MS and are often associated with significant functional impairment and decreased quality of life. This review discusses the proposed pathophysiology of MS relapses, triggering factors, associated markers, variants of clinical presentation, and diagnostic recommendations.
Most MS exacerbations are followed by a period of repair leading to clinical remission; however, residual deficits may persist after MS relapse and contribute to the stepwise progression of disability. Treatment of MS relapses is important as it helps to shorten the duration of disability associated with their course. Successful treatment of relapse helps patients with MS obtain a vital sense of being able to gain control over the disease. Patients with relapsing MS who receive treatment report better outcomes than those who are simply observed. This article discusses treatment options for MS relapse, including systemic corticosteroids, adrenocorticotropic hormone, and plasma exchange. Recent findings related to the mechanisms of action of steroids and adrenocorticotropic hormone are also reviewed, and other potential therapies are assessed. A proposed algorithm for MS relapse management is presented, including strategies for steroid-resistant MS exacerbations.
MS relapses need to be recognized in a timely manner and treated using recommended therapeutic methods.
Address correspondence to Dr Regina Radner Berkovich, Keck School of Medicine, University of Southern California, USC Neurology, 1520 San Pablo St, Suite 3000, Los Angeles, CA 90033, firstname.lastname@example.org.
Relationship Disclosure: Dr Berkovich has served on the advisory boards of Bayer AG, Biogen, Mallinckrodt Pharmaceuticals, Novartis AG, Sanofi Genzyme, and Teva Pharmaceutical Industries Ltd, and as a consultant for Acorda Therapeutics; Avanir Pharmaceuticals, Inc; Biogen; Sanofi Genzyme; and Teva Pharmaceutical Industries Ltd. Dr Berkovich has received personal compensation for speaking engagements from Acorda Therapeutics; Avanir Pharmaceuticals, Inc; Biogen; Novartis AG; Sanofi Genzyme; and Teva Pharmaceutical Industries Ltd.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Berkovich reports no disclosure.