​Here is My Question:
How long can a relapse last for...days, weeks, months?

Answer:
80% of people reach maximal deficits from a relapse in 2 weeks and 90% within 4 weeks. This is followed by a variable period of stability, usually a few days to 2 weeks, followed by slow improvement to a new baseline state with or without residual problems from the relapse. 80% of people reach maximum recovery within 3 months and 90% within 6 months. The rest can take up to a year to recover, although we now know that recovery can continue beyond a year if the underlying disease is thoroughly controlled.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
During an exacerbation, what is happening to the nerve cells to cause the body to respond?

Answer:
During an MS exacerbation, some unknown event or stimulus within a circumscribed region of your nervous system precipitates an inflammatory reaction. This inflammatory cycle includes breakdown of the blood brain barrier (often but not always identified briefly by contrast enhancement after an MRI) and recruitment of inflammatory cells (lymphocytes and macrophages) to the region. This less to further inflammatory injury to myelin and neural elements. Many of the initial symptoms of a relapse are caused by temporarily malfunctioning of neural elements that recover quickly. Resolution of other symptoms require clearance of myelin debris, remyelination and repair of synaptic connections. This can take weeks or months to complete. Axons that are transacted (cut in half) are irreversibly injured and cause permanent tissue damage and sometimes permanent symptoms. 

The inflammation is eventually brought under control spontaneously, damaged tissue is cleared of debris, oligodendrocyte progenitor cells (the ones that make myelin) are recruited to the site of injury and attempt to repair demyelinated axons (with some partial success), dendrites sprout from neurons to create new connections and an astroglial scar is formed. 

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Here is My Question:
I have the flu, vomiting, diarrhea and can hardly move. Will my MS get better soon?

Answer:
Gastrointestinal flu viruses, often make MS symptoms worse for direct or indirect reasons. Direct reasons may include fever or activation of your immune system; secondary reasons can include dehydration, electrolye imbalances and failure to absorb needed medications. More severe GI infections can cause bleeding and severe anemia.

The most important thing is to notify your doctor and make sure your underlying “Flu” symptoms are due to a common virus and not some other condition. Most GI flu that cause vomiting and diarrhea last no more than a day or two. 

Other than this recommendation, it is most important that you stay well hydrated and keep your temperature down. If your mobility is significantly affected and you are finding it harder to take care of yourself, you may need to go into the hospital for treatment.

Hope you feel better soon.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
I've had RRMS for 5 years. The first year and a half I had 3 relapses requiring IV steroids. Then I was free from relapse for 3 years until November when my mother passed. I cannot get back to my pre- November self, despite 2 rounds of steroids; one in December and one in March. I fear I won't recover any time soon or worse that some of my NEW symptoms such as bladder problems, increased spasticity in my legs, increased exhaustion, ringing ears, cog fog increase especially struggling with word usage and spelling etc. will stay with me. What are the odds of my regaining my pre-November self?? 10%? 90%? Or is it impossible to tell? I'm a big girl I can handle the truth and prefer it. Thank you!!

Answer:
It is not possible to give you an answer in percentages with the information provided, but I can can provide some insights that may help. First, you seem to have at least one risk factor for more rapid MS disease progression; that is, you experienced 3 relapses with 18 months of MS symptom onset. This places you at higher risk, all other information being equal, of developing persistent and significant MS related problems within 5 to 10 years of symptom onset. Independent features that would suggest a greater risk of early problems include age > 35 at onset, a large amount of apparent disease related to MS (the white spots) on your MRI at onset and significant new MRI activity over the first 5 years. For these reasons, you require an evaluation by an MS specialist to determine if you should be treated with a highly active disease modifying therapy for your MS to prevent further worsening and potentially enhance recovery.

This being said, you experienced your most recent relapse almost 6 months ago. While 80% to 90% of individuals will experience their maximal recovery from a relapse within 6 months, it is possible, if not likely, that improved management of the symptoms and problems mentioned in your question will lesson their impact on your every day life. This may include treatment of any persistent depression and sleep disruption, improved management of bladder dysfunction and aggressive rehabilitation through aerobic fitness and weight training. Please discuss all of these issues with your MS specialist and see if you can get yourself on the road to recovery soon.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
I have RRMS and have done well for the last 4 years. I have begun to have pain in my legs, one day it is my knee and thigh and then the next day it is my shins and then floats around to another place. I have numbness across the upper part of my back and those goosebumps feelings up and down my legs. Could this be a relapse or just a continuation of the disease? I am almost 60 and hate not being able to get a good walk in without pain.

Answer:
Your symptoms certainly sound annoying but do not sound like a relapse. It will be important to discuss these symptoms with your MS specialist and find ways to continue with your activity level. For instance, pain in the knee may be due to a foot drop and requires a specific treatment whereas fluctuation and migrating burning pain may be neuropathic and require another treatment.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego