Treatment of acute exacerbations of multiple sclerosis in adults
- Michael J Olek, DO
Michael J Olek, DO
- Associate Professor of Neurology
- Loma Linda University Medical Center
- Jonathan Howard, MD
Jonathan Howard, MD
- Assistant Professor of Neurology and Psychiatry
- NYU Langone School of Medicine
Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system that is a leading cause of disability in young adults.
Despite dramatic advances in the clinical assessment of MS due to the widespread availability of brain and spine MRI, our understanding of the basic etiology of the disease remains limited. Full control of the disease and the repair of damaged myelin are key objectives for current and future investigators.
The treatment of acute exacerbations of MS is reviewed here. Other aspects of MS treatment are discussed separately. (See "Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults" and "Treatment of progressive multiple sclerosis in adults" and "Symptom management of multiple sclerosis in adults".)
Attacks in MS are defined as episodes of focal neurologic disturbance lasting longer than 24 hours with a preceding period of clinical stability of at least 30 days and without an alternate explanation such as infection or fever. Indications for treatment of an acute attack (eg, relapse, exacerbation, flare) in patients with MS include functionally disabling symptoms with objective evidence of neurologic impairment such as loss of vision, diplopia weakness, and/or cerebellar symptoms. Mild sensory attacks often are not treated in the same manner, although symptomatic relief is sometimes necessary because of patient discomfort (eg, due to paresthesia).
Most patients with a suspected attack should be evaluated with an MRI of the brain or spinal cord, which will typically show a new lesion that enhances with the administration of gadolinium. This finding can help distinguish an attack from a "pseudo-relapse," the temporary worsening of existing MS symptoms in the setting of heat exposure or infection. However, an MRI is not obligatory if the clinical suspicion for an MS relapse is high or if the relapse is mild (eg, sensory only).
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