What Is an MS Flares or MS Relapse?
Multiple Sclerosis (MS) is a persistent autoimmune disorder that impacts the brain, optic nerves, and spinal cord. Autoimmune disease is when one's immune system attacks the body cells. Depending on the symptoms, Multiple Sclerosis (MS) is of two types:
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Relapsing-Remitting:
In Relapsing-Remitting MS, new symptoms or the deterioration of existing symptoms are observed. Relapses occur in this type of MS.
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Progressive MS:
Progressive MS is characterized by the condition's progression and the worsening and buildup of symptoms over time. It is further classified as primary and secondary progressive MS. Relapses are rare in progressive MS.
MS Flares are also called MS Relapses, episodes, attacks, or exacerbations. MS Flares can appear as a new neurological symptom or worsening of an existing symptom. The symptoms occur spontaneously and can last for a day. Anything controlled by the brain, optic nerve, and spinal cord are affected.
To be categorized as an MS flare, the following conditions should be satisfied:
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Symptoms should last a minimum of a day, though they may last for days or weeks.
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A minimum interval of 30 days is recommended from the onset of the previous relapse.
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Either new symptoms appear or existing symptoms get worse.
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There should be no other underlying cause that explains the symptom.
When Does an MS Flare Become an Emergency in a Child?
Most of the MS Flares that occur in a child are mild and do not require any treatment. However, if severe symptoms develop, then immediate medical attention is needed. An MS Flare in a child becomes a medical emergency if the child presents with any one or more of the symptoms:
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Sudden loss of vision.
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Severe pain that restricts one's functionality.
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The appearance of new symptoms accompanied by fever.
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Severe fever.
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Pain while urinating.
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Breathing difficulty.
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Loss of consciousness.
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Profound leg weakness and challenges with walking may be experienced in either one or both legs.
If the child experiences the above symptoms or other symptoms of a severe flare, immediate medical attention is required. In comparison with adults, MS Flares in children shows the following differences:
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Relapse frequency is more in children when compared to adults with early MS. Studies show that relapse is two to three times more in children, and this increased frequency persists for at least six years following disease onset.
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Relapses show a polysymptomatic(more than one type of symptom) presentation in children compared to adults.
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Children recover from relapse more quickly than adults. Adults may take six to eight weeks to recover compared to four weeks in children.
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Pediatric MS mainly presents as a relapsing-remitting type, while the progressive type is common in adults. In children, the frequency of progressive MS is less than seven percent.
Types of relapse according to symptoms include:
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Sensory Relapse- Affects sensation.
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Cognitive Relapse - Affects cognition.
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Mixed Relapse - Affects two or more systems.
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Motor Relapse - Weakness.
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Optic Neuritis - Blurring of eye vision.
How Are MS Flares in Children Treated?
Severe MS Flares in children are treated with corticosteroids. Other treatment options are also used. The treatment options for MS Flares in children include the following:
1. Corticosteroids:
Steroids have the ability to diminish inflammation and inhibit the immune system. Steroids can be taken orally or intravenously. Methylprednisolone is commonly used for MS relapse treatment.
The use of steroids diminishes inflammation and exerts immunosuppressive effects on the immune system. Steroids can be taken orally or intravenously. Methylprednisolone is commonly used for MS relapse treatment. Side effects of using steroids include the following:
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Insomnia (Difficulty in sleeping).
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Increased heart rate.
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Rashes.
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Metallic taste.
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Stomach upset.
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Acne
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Flushing of the face.
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Fluid retention.
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Mood swings.
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Chest pain.
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Excessive sweating.
Less frequently, dexamethasone can also be used in place of IV methylprednisolone.
2. Plasma Exchange:
If MS relapse presents with severe symptoms and the child does not respond to steroid treatment, plasma exchange is done in a hospital setting. This procedure is called plasmapheresis. The child's blood is taken from the body, and the blood cells and plasma are separated using a machine. Blood cells are transfused back into the body along with donor plasma. It helps in clearing pathogenic antibodies.
The side effects of plasma exchange include:
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Allergic reaction.
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Irregular heartbeat.
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Infection.
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Thrombocytopenia (decrease in platelets).
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Anemia.
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Bleeding.
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Hypoalbuminemia.
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Increased risk of thrombosis.
3. Rehabilitation:
If severe MS Flares severely affect the child's cognitive and physical abilities, then rehabilitation therapy is required, and it helps in the following ways:
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Physical therapy for managing balance, stiffness, spasms, etc. The physiotherapists give home-based exercises to improve the symptoms.
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Speech therapy is helpful in cases where the child experiences difficulties in swallowing and speech.
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Occupational therapy to help the child cope with routine tasks at home and school.
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Cognitive therapy in cases where the child has behavioral problems or problems with cognition.
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Nursing care for bladder and bowel management.
4. Medications:
If the child develops new symptoms during a relapse, the physician recommends medications for correcting the symptoms. For example, medicines may be prescribed for the following conditions:
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Severe fatigue.
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Musculoskeletal pain.
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Nerve pain.
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Bladder problems.
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Bowel problems.
5. Disease Modifying Therapies:
Disease-modifying therapies are helpful in relapsing-remitting MS. They prevent further relapses but have minimal effect on presently occurring relapses. They help in reducing the severity and frequency of relapses.
6. Immunosuppressive Drugs:
Immunosuppressive medications are employed to inhibit or suppress the immune system.
7. Glatiramer Acetate:
Glatiramer Acetate blocks the immune system from attacking myelin.
8. Beta Interferon:
Beta interferons regulate the immune system and help fight viral infection.
Conclusion
Pediatric MS is almost exclusively diagnosed as a relapsing-remitting type. Progressive MS is rare in children, with an incidence of less than seven percent. On the other hand, in adults, progressive MS is more common. So, relapses are more frequent in children than in adults. In most cases, these relapses are mild and require no treatment. However, in cases where the child presents with severe flares, immediate medical attention is required. In such cases, physicians usually start with steroid therapy, followed by plasma therapy and other disease modification therapies.
