What Causes MS Attacks?

The cause of a multiple sclerosis attack, also known as an exacerbation or flare-up, is inflammation in the central nervous system. What causes this inflammation is the topic of much research; stress and temperature changes are two possible culprits that scientists are examining.

What is MS?

• MS stands for multiple sclerosis. It's an autoimmune disease in which your body attacks the fatty coating, or myelin, that surrounds and protects the nerves of your brain and spinal cord. Once the myelin has been eaten away, it's harder for the brain and body to communicate with each other. The myelin may be missing in several places at once, and these damaged places form scars, also known as lesions, or scleroses--hence the name multiple sclerosis.

Types

• There are four types of MS--they're called disease courses, because they each represent different paths the disease takes as time progresses. Primary-progressive MS involves steady worsening of symptoms, without any discernible peaks or valleys. Secondary-progressive MS moves as steadily as primary-progressive, but more quickly. Progressive-relapsing MS also worsens steadily, but is accompanied by attacks of severe symptoms, also known as flare-ups or exacerbations. The patient may or may not recover from these attacks, but definitely doesn't experience any remission. The last course is relapsing-remitting MS, which is the most common type of the disease that patients are initially diagnosed with. In this form of MS, the patient has exacerbations from which he or she may partially or completely recover. These periods of recovery are called remissions, and the attacks are called relapses.

Exacerbations

• Multiple sclerosis exacerbations are also known as relapses or attacks. They're caused by inflammation in the central nervous system, which damages the myelin coating on the nerves. They involve a sudden worsening of already-present symptoms, or the appearance of new symptoms. According to the National MS Society, an exacerbation lasts at least 24 hours and occurs at least one month after the last attack.

Stress

• It's thought that stress might bring on inflammation and thus exacerbations. A study conducted by doctors at the University of Pittsburgh in 2002, and published in the journal Psychosomatic Medicine, showed that after stressful life events, patients with relapsing-remitting MS were more likely to have exacerbations than they were during normal, relatively stress-free life patterns.

Temperature Change

• A rise in a patient's core body temperature may increase symptoms of MS. However, when the body cools down, the symptoms disappear. This is known as a pseudoexacerbation--it feels like an MS attack, but in fact, no new lesions have formed on nerves. The summer months may bring on pseudoexacerbations for some MS patients. If a patient is running a fever, this may also produce a false flare-up. Also, if a patient does vigorous exercise, it may lead to a pseudoexacerbation. Female MS sufferers who are premenstrual also often report false flare-ups, since body temperature tends to elevate slightly before the menstrual period. A 2006 study conducted by the Department of Neurology at the Mayo Clinic College of Medicine and published in the Archives of Neurology found that aspirin could reduce these symptoms until the body temperature lowered.

Symptoms

• The symptoms of an exacerbation vary widely from patient to patient. They can include fatigue; problems with balance; pain, tingling or burning in one or both legs or on one side of the body; facial pain; problems with sight, like blurred or double vision; urinary tract infections; urinary incontinence or difficulty urinating; muscle spasms or partial paralysis; difficulty swallowing; issues with forgetfulness or clarity of thought; foot drop, which is a muscular gait disorder that hinders walking; slurred speech; and intolerance of heat.

Treatment

• Mild attacks that don't affect a patient's day-to-day life will usually subside without medical treatment. Doctors often prescribe courses of corticosteroids for severe attacks. These drugs treat the inflammation in the nervous system, helping to ease symptoms. They include prednisone and methylprednisolone, and can be taken orally or intravenously. They help with each exacerbation individually, rather than preventing future attacks. For especially severe attacks, a patient can undergo a treatment called plasmapheresis, which involves taking all the blood from the patient, extracting its plasma, replacing it with "clean" plasma, and reintroducing it into the body. This may help remove antibodies that could spur attacks on myelin. Side effects of plasmapheresis can include infections and blood clotting problems.