49 msfocusmagazine.org The clinical management of multiple sclerosis should be considered as three distinct parallel pathways. First, disease-modifying therapies should be used to decrease the number and severity of relapses, to decrease progression, and to prevent /minimize neuronal damage. Next, medications should be used to treat the various symptomatic problems (e.g., fatigue, depression, bladder problems, bowel problems, and pain) associatedwith MS; these medications prevent and/or treat complications and preserve quality of life. Finally, acute exacerbations (or relapses) should be treated with appropriate therapies. According to Dr. Ben Thrower, MD, Medical Director of the Shepherd Center MS Institute, prompt treatment of relapses can hasten recovery and help patients feel better sooner rather than later. The unpredictable nature of MS makes it difficult to anticipate when relapses will occur. However, certain factors (e.g., infections, hyperventilation, fever, lack of sleep, stress, malnutrition, anemia, childbirth) have been reported to precipitate relapses and aggravate symptoms. When treating relapses, the goal of treatment is to decrease the duration and severityofsymptomsbyreducinginflammation. Dr. Thrower encourages all patients to report relapses to their neurologist because relapse frequency is factored into deciding whether to continue or change DMT regimens. Corticosteroids are considered the mainstay of treatment for relapses. These agents exert their effect by decreasing edema (swelling) in areas of demyelination, restoring the integrity of the blood-brain barrier, inducing T-cell apoptosis (the normal death of these cells), TreatingAcute Exacerbations By Ellen Whipple, Pharm.D. RX Update Characteristics of Relapses • Causes new symptoms or the worsening of old symptoms • Can be very mild, or severe enough to interfere with a person’s ability to function at home and at work • Must last at least 24 hours and be separated from the previous attack by at least 30 days • Cannot be explained • Can last from a few days to several weeks or even months • No two relapses are alike