When it comes to relapses, doctors are not completely certain why a relapse happens when it does, but there do seem to be some triggers that almost always cause a relapse. A very common trigger is heat – a large percentage of MS patients have heat intolerance and in general patients are strongly encouraged to stay cool as much as possible. Hot weather, sun exposure, exercising in a hot and/or humid environment, and fevers/illness can all cause a worsening in symptoms, however it is not associated with additional progression of the disease. Patients are advised to use fans and air conditioning when possible, drink cool drinks and use cold/icy compresses to stay cool. Often, once a person has cooled down, their symptoms will back off within a couple hours, but it can take up to a few days to fully return to their “resting” behavior.
Another known trigger is stress – physical or emotional. When one’s emotions are heightened, especially negative emotions, symptoms can increase as they do with heat intolerance. The difference is stress can cause a full relapse, not a temporary worsening of symptoms (known as a pseudoflare or pseudoexacerbation) and may require steroid treatment to return back to a remission status.
All this information can be extremely overwhelming for someone newly diagnosed, especially if they have little to no knowledge of what Multiple Sclerosis is prior to their diagnosis. There are many more treatment options now than years ago when my father was diagnosed. All medications used to treat MS are called DMTs or Disease Modifying Treatments and have been shown to be very effective in decreasing the frequency of relapses, though just like any other medication, each patient reacts differently to each treatment.
There are three categories of DMTs: oral, injectable, and intravenous. Some oral options are Gilenya and Tecfidera, injectables include Copaxone, Betaseron, and Rebif and the intravenous choices include Tysabri and Novantrone. While DMTs of any variety are effective in most cases of MS, they have not been proven to be effective in cases of Primary-Progressive Multiple Sclerosis.
Dosages vary, but in general, oral medications are taken once a day, injectables either once a daily or once every few days, and the intravenous options are typically infused on either a monthly basis or every few months. Doctors have also found a link between low vitamin D levels and Multiple Sclerosis, so many MS patients are advised to take vitamin D supplements based on their levels in regular blood work. The vitamin can act as a protector against MS, possibly leading to fewer relapses in people who maintain normal vitamin D levels in their bodies.