16 msfocusmagazine.org A common question asked by people living with MS, whether newly diagnosed or veterans to MS, is: “How do I know if I am having a relapse?” Occasionally, a person will tell me that they have had three relapses in a week, or 15 relapses in a month. More frequently, people will call the office asking for steroids because they “just don’t feel well.” These comments are clues to me that relapses remain mysterious and deserve some educational time. A relapse, also called a flare-up or exacerbation, involves a new neurological symptom that lasts longer than 24-48 hours and is not caused byanything else. Sometimes, it can also involve the return or increased severity of an old neurological symptom. On the other hand, a pseudorelapse (pseudoexacerbation) is the increased severity of an old neurological symptom triggered by infection, heat exposure, fatigue, stress, medication changes, alcohol overuse, or dehydration, to name a few. It is important to distinguish between the two for a couple of reasons. 1) Relapses indicate that your MS is active, and suggestyourdisease-modifying therapy may not be effective 2) Relapses and pseudorelapses are treated differently If you have relapsing MS, the root of relapse therapy is taking your DMT as prescribed. Then, depending on severity, relapses are treated with steroid therapy or ACTH gel, as well as rehabilitation therapy. (See Ellen Whipple’s article on page 49 for more on acute relapse treatment.) However, whether or not you treat a relapse has no long-term effect on your MS progression. Pseudorelapses are treated by correcting the underlying problem. This could mean rest and hydration if you have been overdoing it, or an antibiotic if you have an infection, such as a urinary tract infection. Steroids will not fix symptoms of a pseudorelapse. While theymaygiveyouafalsesenseofimprovement for a few days, they are an inappropriate Life with MS Is it a Relapse, a Pseudorelapse, or a Bad Day? by Megan Weigel, MSCN