How Multiple Sclerosis Attacks are Treated | Rethink MS Relapses

How Are Multiple Sclerosis (MS) Relapses Treated?

Relapses or attacks are unpredictable, but they are treatable. Treatment of MS relapses focuses on shortening the length of a relapse and speeding up relapse recovery.


One treatment option currently FDA-approved in the United States is steroids. Other therapies, such as intravenous immunoglobulin G and plasma exchange, may also be prescribed by your HCP even though they are not approved by the FDA. Rehabilitation may also help you regain function. Only you and your healthcare provider can decide what treatment is right for you. 


Learn more about the different MS relapse treatments.

Discover treatment options that can speed recovery of MS relapse symptoms, and questions you can ask your healthcare provider.

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Once a relapse is identified, your healthcare team will work with you to decide if treatment is needed and which treatment may work best for you. In today’s world, you have options. And it’s important to understand all of your options when it comes to treating MS.

Keep in mind that there is no “one-size-fits-all” treatment plan for MS. MS is a highly variable disease, and each person experiences it differently. This is especially true for MS relapses.

When it comes to making treatment plans for my patients, I treat the disease, the symptoms, and the person.

And of the disease managing treatments, there are treatments that slow the course of the disease and prevent relapses. And then there are treatments that treat the relapses.

Disease-modifying treatments slow the course of the disease and prevent relapses. They are taken over the long term—in other words, throughout the course of your MS.

And relapse treatments are taken over the short term and during a relapse. Treating MS relapses has been shown to shorten the length of the relapse, speed the recovery, and lessen disability from relapses in the short term. So what this means is that the faster you get treatment for relapses, the faster you may feel better.

Keep in mind that people usually take relapse treatments with the disease-modifying treatments. In other words, don’t stop taking your regular MS treatment when you’re having a relapse. Just because a relapse is happening doesn’t mean that your disease-modifying treatment isn’t doing its job at preventing relapses. Continue to take it as directed.

I find it helpful when my patients are knowledgeable about—the previous treatments they have taken for their relapses and how each one has affected them. You know, were their symptoms resolved? Did they recover fully? Did they experience any side effects?

A simple summary is enough to let us know about your response to treatment and other changes to your health. Be sure to talk to us about your experience during and after treatment.

Relapses with MS are far fewer than they used to be. But you can become relapse-ready by telling us about your treatment history. That helps us decide whether a change in treatment may be needed for the next relapse.

Intravenous and Oral Steroids

What are intravenous (IV) and oral steroids?

IV and oral steroids (also known as “corticosteroids”) are synthetic prescription drugs that are FDA-approved for the acute, or short-term, treatment of MS relapses, among a variety of other conditions.

How do steroids work to treat MS relapses?

Steroids impact the immune response to reduce the inflammation that contributes to MS relapses. Steroids have not been proven to change the course of the disease.

How are steroids given?

Steroids are given intravenously (injected into a vein) or orally (by mouth).

What are potential side effects of steroids?

Potential side effects of steroids include:

  • Increased risk of infections
  • Effects on the adrenal glands during and after treatment
  • Increased blood pressure, salt, and water retention levels
  • Unpredictable response to vaccines
  • You should not receive certain vaccines during treatment with steroids
  • Masking (hiding) of other conditions or diseases
  • Stomach or intestinal problems
  • Changes in mood or behavior
  • Worsening of other medical conditions, such as diabetes or eye problems
  • Allergic reactions (skin rash, swollen face, or trouble breathing)
  • Potential negative effect on bone density
  • Fetal harm


Common side effects of steroids include fluid retention, changes in glucose tolerance, increased blood pressure, behavior or mood changes, increased appetite, and weight gain.

These are not all of the possible side effects of steroids. Talk to your healthcare provider about the side effects associated with these medications.



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Plasma Exchange

What is plasma exchange?

Plasma exchange (also called “plasmapheresis”) is not approved by the FDA for treating MS relapses. However, the American Academy of Neurology recommends using plasma exchange in severe relapses when an individual does not respond well to steroids.

How does plasma exchange work to treat MS relapses?

In plasma exchange, the blood is taken out of the body and parts of the blood’s plasma thought to be involved in MS are removed. The blood is then put back into the body with replacement plasma.

How is plasma exchange given?

Treatment is given in several sessions, each 48 hours apart.

What are potential side effects of plasma exchange?

The side effects listed below are only some possible side effects of plasma exchange. There may be other potentially serious side effects that can occur.  

  • Nausea
  • Low blood pressure
  • Burning or prickling sensation (“pins and needles”) in the arms and legs
  • Complications related to the way the treatment is given

As noted above, these are not all of the possible side effects of plasma exchange. Talk to your healthcare provider about the side effects associated with this procedure. Only you and your healthcare provider can decide what treatment is right for you.



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Intravenous Immunoglobulin G (IVIG)

What is IVIG?

Intravenous immunoglobulin G, or IVIG, is not approved by the FDA for treatment of MS relapses. IVIG is a prescription treatment that is sometimes used in people who do not respond to or cannot take steroids.

How does IVIG work to treat MS relapses?

IVIG is a solution of concentrated antibodies that have been extracted from healthy donors. It is unknown how exactly IVIG works, but it is believed that IVIG affects the body’s immune response.

How is IVIG given?

IVIG is infused into a vein or injected under the skin over several sessions.

What are potential side effects of IVIG?

WARNING: ACUTE RENAL DYSFUNCTION AND ACUTE RENAL FAILURE

  • Renal dysfunction, acute renal failure, osmotic nephrosis, and death may occur with immune globulin intravenous (IGIV) products in predisposed patients. Patients predisposed to renal dysfunction include those with any degree of pre-existing renal insufficiency, diabetes mellitus, age greater than 65, volume depletion, sepsis, paraproteinemia, or patients receiving known nephrotoxic drugs.
  • Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. For patients at risk of renal dysfunction or failure, administer IVIG at the minimum infusion rate practicable.

Serious side effects of IVIG can include:

  • Severe allergic reactions causing difficulty in breathing or skin rashes
  • Decreased kidney function or kidney failure
  • Blood clots in the heart, brain, lungs, or elsewhere in the body
  • Severe headaches, drowsiness, fever, painful eye movements, or nausea and vomitings
  • Dark colored urine, swelling, fatigue, and difficulty breathing

Common side effects of IVIG include infusion site reactions (mild or moderate pain, swelling, itching, redness, bruising, warmth), headache, migraine, fever, fatigue, itching, rash/hives, cough, chest pain/tightness, chills/shaking chills, dizziness, nausea/vomiting, faster heart rate, upper abdominal pain, increased blood pressure, muscle cramps, and sore throat.

These are not all of the possible side effects of IVIG. Talk to your healthcare provider about the side effects associated with IVIG. Only you and your healthcare provider can decide what treatment is right for you.



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What’s Next? MS Treatments under Investigation

Scientists continue to research treatment options for MS relapses. Right now, ongoing clinical trials are evaluating:

  • Intravenous steroids for MS attacks (relapses)
  • Oral steroids for MS attacks (relapses)
  • Plasma exchange for neuromyelitis optica (a condition related to MS)


Search for ongoing clinical trials at ClinicalTrials.gov.



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relapse
A period when old symptoms get worse or new symptoms appear.
rehabilitation
Physical and occupational therapy to restore function for daily living.
immune response
The reaction of the body to substances that are foreign or are interpreted of being foreign.
inflammation
A reaction characterized by swelling, increase in white blood cells, pain, and loss of function at the site of injury.
cortisol
A hormone that lessens inflammation and lowers the immune response.
immunoglobulin G
The most common kind of antibodies that circulate in the blood to destroy foreign bodies during an immune response.