PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: MS relapses need to be recognized in a timely manner and treated using recommended therapeutic methods.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: MS relapses need to be recognized in a timely manner and treated using recommended therapeutic methods.
Authors: Johannes Ehler; Stephan Blechinger; Paulus S Rommer; Sebastian Koball; Steffen Mitzner; Hans-Peter Hartung; Fritz Leutmezer; Martin Sauer; Uwe K Zettl Journal: Int J Mol Sci Date: 2017-08-11 Impact factor: 5.923
Authors: Elisa Carolina Jácome Sánchez; María Ariana García Castillo; Victor Paredes González; Fernando Guillén López; Edgar Patricio Correa Díaz Journal: Mult Scler J Exp Transl Clin Date: 2018-04-08
Authors: Leoni Rolfes; Steffen Pfeuffer; Tobias Ruck; Nico Melzer; Marc Pawlitzki; Michael Heming; Marcus Brand; Heinz Wiendl; Sven G Meuth Journal: J Clin Med Date: 2019-10-04 Impact factor: 4.241
Authors: Daniel Wynn; Lawrence Goldstick; William Bauer; Enxu Zhao; Eva Tarau; Jeffrey A Cohen; Derrick Robertson; Aaron Miller Journal: CNS Neurosci Ther Date: 2022-01-04 Impact factor: 5.243
Authors: Steffen Pfeuffer; Leoni Rolfes; Heinz Wiendl; Sven G Meuth; Timo Wirth; Falk Steffen; Marc Pawlitzki; Andreas Schulte-Mecklenbeck; Catharina C Gross; Marcus Brand; Stefan Bittner; Tobias Ruck; Luisa Klotz Journal: J Neuroinflammation Date: 2022-09-07 Impact factor: 9.587