Management of Multiple Sclerosis Relapses

Pavle Repovic, MD, PhD Multiple Sclerosis and Other CNS Inflammatory Diseases p. 655-669 June 2019, Vol.25, No.3 doi: 10.1212/CON.0000000000000739
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PURPOSE OF REVIEW: This article provides an overview of the clinical and pathologic features of multiple sclerosis (MS) relapses and reviews evidence-based approaches to their treatment.

RECENT FINDINGS: Despite the increasing number and potency of MS treatments, relapses remain one of the more unpredictable and disconcerting disease aspects for many patients with MS, making their accurate recognition and treatment an essential component of good clinical care. The expanding range of relapse treatments now includes oral corticosteroids, comparable in efficacy to IV methylprednisolone at a fraction of the cost. While this development improves access to prompt treatment, it also underscores the importance of recognizing mimics of MS relapses to reduce corticosteroid overuse and its attendant risks.

SUMMARY: Like MS itself, MS relapse remains primarily a clinical diagnosis. The treatment options for MS relapse include corticosteroids, adrenocorticotropic hormone (ACTH), plasma exchange, and rehabilitation, used singly or sequentially, with the goal of limiting the duration and impact of associated disability. Even when treated promptly and effectively, clinical or subclinical sequelae of MS relapses frequently remain.

Address correspondence to Dr Pavle Repovic, MS Center, Swedish Neuroscience Institute, 1600 E Jefferson St, Ste A, Seattle, WA 98122, pavle.repovic@swedish.org.

RELATIONSHIP DISCLOSURE: Dr Repovic has served as a consultant for Biogen; EMD Serono, Inc; Genentech, Inc; Sanofi Genzyme; and Teva Pharmaceutical Industries Ltd and has received personal compensation for speaking engagements from Biogen; EMD Serono, Inc; Genentech, Inc; and Teva Pharmaceutical Industries Ltd. Dr Repovic receives research/grant support from Alexion, the National Institutes of Health (5U10NS077309), Novartis AG, and Genentech, Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Repovic reports no disclosure.

© 2019 American Academy of Neurology.