What symptoms indicate a relapse or disease progression in multiple sclerosis (MS)?

Recognizing Relapse or Disease Progression in Multiple Sclerosis

Patients with MS should monitor for any new neurological symptoms lasting more than 24 hours or significant worsening of existing symptoms that persist for several days, as these indicate a potential relapse or disease progression requiring medical attention. 1

Key Symptoms to Monitor

Relapse Indicators (New or Worsening Symptoms)

• Vision problems:

  • Blurred vision, double vision, or vision loss in one eye
  • Eye pain, especially with movement
  • Color vision changes

• Motor symptoms:

  • New or increased weakness in limbs
  • Worsening gait difficulties or balance problems
  • Decreased dexterity or coordination
  • New tremors or unsteadiness

• Sensory symptoms:

  • New areas of numbness or tingling
  • Increased or new pain sensations
  • Changes in temperature perception
  • New sensations of tightness or band-like feelings

• Bladder/Bowel function:

  • New or worsening urinary urgency or frequency
  • Incontinence that wasn't present before
  • New constipation or bowel control issues

• Cognitive changes:

  • New or worsening memory problems
  • Difficulty concentrating or processing information
  • Word-finding difficulties
  • Mental fatigue that interferes with daily activities

• Other important symptoms:

  • New or worsening fatigue not explained by other factors
  • Speech changes (slurring or difficulty articulating)
  • Swallowing difficulties
  • Vertigo or dizziness

Distinguishing True Relapses from Pseudorelapses

It's crucial to differentiate true relapses from temporary symptom fluctuations (pseudorelapses) 2:

1. Duration: True relapses last at least 24-48 hours, while pseudorelapses are typically shorter

2. Triggers: Pseudorelapses often occur with:

   • Fever or infection
   • Heat exposure
   • Physical exhaustion
   • Stress
   • Lack of sleep

3. Resolution: Pseudorelapse symptoms typically resolve when the trigger is addressed

When to Seek Medical Attention

Patients should contact their healthcare provider when:

1. Any new neurological symptom appears and persists for more than 24 hours
2. Existing symptoms worsen significantly and don't improve after removing potential triggers
3. Multiple symptoms occur simultaneously
4. Symptoms interfere with daily functioning or quality of life

Disease Course Patterns to Recognize

Different MS patterns have distinct symptom presentations 3:

• Relapsing-Remitting MS: Discrete episodes of symptoms with periods of stability between attacks
• Secondary Progressive MS: Gradual, steady worsening of function with or without superimposed relapses
• Primary Progressive MS: Continuous deterioration from disease onset without distinct relapses

Practical Symptom Monitoring Approach

Using a systematic approach like the SymptoMScreen tool 4 can help patients track symptoms across 12 key domains:

1. Mobility
2. Dexterity
3. Body pain
4. Sensation
5. Bladder function
6. Fatigue
7. Vision
8. Dizziness
9. Cognition
10. Depression
11. Anxiety
12. Spasticity

Patients should rate each domain regularly (weekly or monthly) on a severity scale to identify patterns and changes.

Common Pitfalls in Symptom Recognition

• Attributing all symptoms to MS: Not all new symptoms are MS-related; concurrent conditions should be considered
• Ignoring gradual changes: Slow progression can be missed if not systematically monitored
• Delaying reporting: Early intervention for true relapses can improve outcomes
• Misinterpreting pseudorelapses: Temporary symptom fluctuations due to triggers are not true relapses
• Focusing only on physical symptoms: Cognitive and emotional changes are important indicators of disease activity

Regular symptom monitoring and prompt reporting of persistent new or worsening symptoms are essential for optimal MS management and can significantly impact long-term quality of life and disease outcomes 5, 6.