This research paper describes the testing of a questionnaire to help health professionals assess whether symptoms are due to a relapse and what treatment might be best. It describes the most common symptoms found in a relapse and their impact on daily living. The effectiveness of treatments for a relapse and the most common side effects are given.
About 85% of people are diagnosed with the relapsing remitting form of MS. A relapse is the appearance of a new symptom or the reappearance of old symptoms that lasts more than 24 hours. A relapse can last much longer than 24 hours, sometimes for weeks or months. It is not possible to predict how often someone will have relapses or how severe or long lasting the symptoms will be.
In addition, it can sometimes be difficult to tell what is a relapse and what is part of the typical up and down pattern of MS symptoms from day to day. This is a challenge for people living with MS but also for their health professionals.
How this study was carried out
This study aimed to develop a short questionnaire (called ARMS) that would help health professionals work out whether someone was having a relapse or not and whether treatment made a positive difference. The questionnaire was developed by a group of MS nurses in the USA.
The first questionnaire was completed when someone presented with a possible relapse. It aimed to assess symptoms, how much they were affecting daily life and whether treatment for their last relapse had worked well. This information would then guide treatment for the current symptoms.
The questions were:
- What are the new or worsening symptoms that you are currently experiencing?
- When did these symptoms begin?
- How much have these symptoms affected your daily activities or overall function?
- How many days/months ago was your last relapse prior to this current episode?
- What treatment did you receive for your last relapse?
- After treatment for your last relapse, how much did you return to your baseline state of health without any residual relapse symptoms?
- Have you had any side effects from treatments for previous MS relapses?
For each question, a number of possible answers were offered. You can see the full questionnaire by clicking on Supplementary material 1 at the bottom of the page in this link.
The second questionnaire was completed if symptoms were judged to be due to a relapse and one month after treatment had begun. It looked at whether symptoms had improved, whether the person was able to carry out the tasks of every day life more easily and whether there were any side effects of the treatment.
Again, for each question, a number of possible answers were offered. You can see the full questionnaire by clicking on Supplementary material 2 at the bottom of the page in this link.
The answers to both questionnaires were scored as explained in the Data Analysis section of the full paper
103 people with MS at five centres in the USA took part in the test run of the questionnaires. Most questionnaires were completed in the office (93%), rather than by phone, and were completed by the person with MS (86%) rather than their health professional.
What was found
The researchers found that the most common symptoms during a relapse were numbness/tingling (reported by two thirds of participants), fatigue and leg/foot weakness (just over half of the participants for each of these). A diagram of all the different symptoms, and how may people experienced, them can be seen here.
Almost half reported that daily living was very much affected by their symptoms and another one in ten participants said that daily living was severely affected.
The treatments prescribed for a relapse included intravenous and/or oral corticosteroids (seven out of every eight participants) and adrenocorticotropic hormone (one in eight participants).
One in six people reported that their symptoms had completely disappeared, and another one in three reported that they were very much better, one month after treatment began.
The most common side effects were problems sleeping in almost half (45%) of participants, mood changes in a third (33%) and weight gain and increased appetite in just over a quarter (29% and 26% respectively). A diagram of the full list can be seen here along with the corresponding treatments.
What does it mean?
The authors suggest that the ARMS questionnaire will be useful for health professionals when assessing possible relapses and will complement existing measures such as the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC).
Perrin Ross A, Williamson A, Smrtka J, et al.
Assessing relapse in multiple sclerosis questionnaire: results of a pilot study..
Mult Scler Int. 2013;2013:470476.
Read the full text of this paper
More about relapses
If you are worried that you may be having a relapse, it is important to rule out an infection as a possible cause of increased or new symptoms. Urinary tract or respiratory infections, such as a cough or cold, are prime suspects. Also, MS symptoms tend to be up and down even at the best of times so this may be the cause of the variation. However, if you are worried or symptoms persist, it is best to contact your MS nurse or other health professional for advice.
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