My Relapse Report

The information entered by you into the My Relapse Report is for your personal health records only. It is in no way monitored or stored by Mallinckrodt.

Symptoms

What are the new or worsening MS symptoms you are currently experiencing? Check all boxes that apply.
For more information about each symptom, scroll over the symptom with your mouse. When you are finished, click “Next.”
Bladder problems
Includes urinary frequency (needing to go often), urgency (feeling an urgent need to go), and loss of bladder control or leaking, as well as retaining large amounts of urine.
Bowel problems
Includes constipation, stool leakage, and loss of bowel control.
Chewing/swallowing
Signs of difficulty chewing or swallowing food include gurgling sounds, spitting or coughing after meals, having a hard time “getting food down,” throat clearing, choking, and weak voice.
Coordination (tripping, dropping things)
Loss of coordination of larger movements and problems making small movements.
Tripping, Dropping things
Loss of coordination of larger movements and problems making small movements.
Difficulty walking
Many people with MS have difficulty walking and balancing, most commonly due to unsteady, uncoordinated movements (called “ataxia”).
Dizziness/poor balance
Balance is needed to perform coordinated movements, whether you are standing, sitting, or lying down.
Fatigue
Includes both physical fatigue, such as tiredness in the limbs, and an overall feeling of tiredness, which can result from depression or sleep disturbances.
Hand/arm weakness
Includes muscle weakness and hyper-reflexia.
Leg/foot weakness
Includes muscle weakness and hyper-reflexia.
Memory problems
Includes trouble thinking quickly or clearly, trouble remembering, being easily distracted, or having trouble remembering words. You may feel as if the right word is just on the tip of your tongue.
Muscle tightness or stiffness
Includes muscle tightness and spasticity (muscles that are stiff or go into spasms without warning). Muscle spasticity may limit joint mobility or affect walking.
Stiffness
Includes muscle tightness and spasticity (muscles that are stiff or go into spasms without warning). Muscle spasticity may limit joint mobility or affect walking.
Numbness/tingling
Includes loss of sensation in any area of the body and increased sensations in any area of the body (tingling).
Pain, burning, itching
Includes burning and prickling (pins and needles); sharp, stabbing facial pain (called trigeminal neuralgia); central pain; and chronic back or other muscle and bone pain.
Sexual problems
Includes problems with arousal and orgasm. Sexual function may also be affected by other MS symptoms, including fatigue and spastic muscles.
Speech changes
Includes slurred speech (called “dysarthria”), slowed speech, and loss of fluency (or smoothness in speech).
Thinking problems
Includes problems with planning and judgment, which may affect job performance or daily functioning. May also include mood changes like depression or inappropriate or involuntary expressions of laughter, crying, or anger (called pseudobulbar affect).
Vision changes
Vision problems are common in MS, but rarely lead to permanent blindness. Changes in vision include blurring, graying of vision, blindness in one eye, loss of normal color vision, changes in depth perception, or a dark spot in the center of vision (called scotoma). Other eye problems include uncontrolled eye movements (called nystagmus), “jumping vision” (called opsoclonus), and pain on eye movements and double vision (called diplopia).