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MS research update - How do you know whether it's a relapse or not? - 19 June 2013

Summary

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.

Background

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.
abstract
Read the full text of this paper

More about relapses

You can read more about relapses and relapsing remitting MS in the A to Z of MS.

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.

Research by topic areas...

Symptoms and symptom management

Kanekar N, Aruin AS.
The role of clinical and instrumented outcome measures in balance control of individuals with multiple sclerosis.
Mult Scler Int. 2013;2013:190162.
abstract
Read the full text of this paper

Merghati-Khoei E, Qaderi K, Amini L,, et al.
Sexual problems among women with multiple sclerosis.
J Neurol Sci. 2013 Jun 10. doi:pii:S0022-510X(13)00221-9. 10.1016/j.jns.2013.05.014. [Epub ahead of print]
abstract

Veauthier C, Gaede G, Radbruch H, et al.
Treatment of sleep disorders may improve fatigue in multiple sclerosis.
Clin Neurol Neurosurg. 2013 Jun 10. doi:pii: S0303-8467(13)00174-1.10.1016/j.clineuro.2013.05.018. [Epub ahead of print]
abstract

Knippenberg S, Damoiseaux J, Bol Y, et al.
Higher levels of reported sun exposure, and not vitamin D status, are associated with less depressive symptoms and fatigue in multiple sclerosis.
Acta Neurol Scand. 2013 Jun 13. doi: 10.1111/ane.12155. [Epub ahead of print]
abstract

Mezei Z, Olah L, Kardos L, et al.
Cerebrovascular hemodynamic changes in multiple sclerosis patients during head-up tilt table test: effect of high-dose intravenous steroid treatment.
J Neurol. 2013 Jun 12.[Epub ahead of print]
abstract

Prosperini L, Petsas N, Raz E, et al.
Balance deficit with opened or closed eyes reveals involvement of different structures of the central nervous system in multiple sclerosis.
Mult Scler. 2013 Jun 11. [Epub ahead of print]
abstract

Jackson K, Bigelow KE.
Measures of balance performance are affected by a rested versus fatigued testing condition in people with Multiple Sclerosis.
PM R. 2013 Jun 5. doi:pii: S1934-1482(13)00309-2. 10.1016/j.pmrj.2013.06.001. [Epub ahead of print]
abstract

Solaro C, Rezzani C, Trabucco E, et al.
Prevalence of patient-reported dysphagia [difficulties swallowing] in multiple sclerosis patients: An Italian multicenter study (using the DYMUS questionnaire).
J Neurol Sci. 2013 Jun 6. doi:pii: S0022-510X(13)00227-X. 10.1016/j.jns.2013.05.020. [Epub ahead of print]
abstract

Feenaughty L, Tjaden K, Benedict RH, et al.
Speech and pause characteristics in multiple sclerosis: a preliminary study of speakers with high and low neuropsychological test performance.
Clin Linguist Phon. 2013 Feb;27(2):134-51.
abstract

Disease modifying treatments

Oliver-Martos B, Orpez-Zafra T, Urbaneja P, et al.
Early development of anti-natalizumab antibodies in MS patients.
J Neurol. 2013 Jun 14. [Epub ahead of print]
abstract

Selmaj K, Li DK, Hartung HP, et al.
Siponimod for patients with relapsing-remitting multiple sclerosis (BOLD): an adaptive, dose-ranging, randomised, phase 2 study.
Lancet Neurol. 2013 Jun 11. doi:pii: S1474-4422(13)70102-9. 10.1016/S1474-4422(13)70102-9. [Epub ahead of print]
abstract

Hutchinson M, Fox RJ, Miller DH, et al.
Clinical efficacy of BG-12 (dimethyl fumarate) in patients with relapsing-remitting multiple sclerosis: subgroup analyses of the CONFIRM study.
J Neurol. 2013 Jun 8. [Epub ahead of print]
abstract

Chan A, Lo-Coco F.
Mitoxantrone-related acute leukemia in MS: an open or closed book?
Neurology. 2013 Apr 16;80(16):1529-33.
abstract

Vågberg M, Kumlin U, Svenningsson A., et al.
Humoral immune response to influenza vaccine in natalizumab-treated MS patients.
Neurol Res. 2012 Sep;34(7):730-3.
abstract

Miller CS, Houff SA, Hopper J, et al.
Disease-modifying drugs for multiple sclerosis and JC virus expression.
J Neurovirol. 2012 Oct;18(5):411-5.
abstract

Other treatments

Stock ML, Fiedler KJ, Acharya S, et al.
Antibiotics acting as neuroprotectants via mechanisms independent of their anti-infective activities.
Neuropharmacology. 2013 Jun 4. doi:pii: S0028-3908(13)00229-3. 10.1016/j.neuropharm.2013.04.059. [Epub ahead of print]
abstract

Ranieri M, Putignano P, Fiore P, et al.
Associated with intrathecal baclofen treatment and duloxetine in patients with multiple sclerosis.
Int J Immunopathol Pharmacol. 2012 Jan-Mar;25(1 Suppl):51S-56S.
abstract

Epidemiology

Alcalde-Cabero E, Almazán-Isla J, García-Merino A, et al.
Incidence of multiple sclerosis among European Economic Area populations, 1985-2009: the framework for monitoring.
BMC Neurol. 2013 Jun 12;13(1):58. [Epub ahead of print]
abstract
Read the full text of this paper

Assessment tools

Prosperini L, Pozzilli C.
The clinical relevance of force platform measures in multiple sclerosis: a review.
Mult Scler Int. 2013;2013:756564.
abstract
Read the full text of this paper

Quality of life

Boucekine M, Loundou A, Baumstarck K, et al.
Using the random forest method to detect a response shift in the quality of life of multiple sclerosis patients: a cohort study.
BMC Med Res Methodol. 2013 Feb 15;13:20.
abstract
Read the full text of this paper

Carers

McCurry MK.
An exploratory study of decision making by informal caregivers of individuals with multiple sclerosis.
J Neurosci Nurs. 2013 Feb;45(1):52-60.
abstract

Chen H, Habermann B.
Ready or not: planning for health declines in couples with advanced multiple sclerosis.
J Neurosci Nurs. 2013 Feb;45(1):38-43.
abstract

Physical activity

Sweet SN, Perrier MJ, Podzyhun C, et al.
Identifying physical activity information needs and preferred methods of delivery of people with multiple sclerosis.
Disabil Rehabil. 2013 Jun 13. [Epub ahead of print]
abstract

Larson RD, McCully KK, Larson DJ, et al.
Bilateral differences in lower-limb performance in individuals with multiple sclerosis.
J Rehabil Res Dev. 2013 Apr;50(2):215-22
abstract

Prognosis

Schlaeger R, D'Souza M, Schindler C, et al.
Electrophysiological markers and predictors of the disease course in primary progressive multiple sclerosis.
Mult Scler. 2013 Jun 11. [Epub ahead of print]
abstract

Pathophysiology

Stys PK.
Pathoetiology of multiple sclerosis: are we barking up the wrong tree?
F1000Prime Rep. 2013 Jun 3;5:20.
abstract
Read the full text of this paper

Provision of care

Roessler RT, Bishop M, Rumrill PD, et al.
Specialized housing and transportation needs of adults with multiple sclerosis.
Work. 2013 Jan 1;45(2):223-35.
abstract

Self-management

Manouchehrinia A, Tench CR, Maxted J, et al.
Tobacco smoking and disability progression in multiple sclerosis: United Kingdom cohort study.
Brain. 2013 Jun 11. [Epub ahead of print]
abstract
Read the full text of this paper

Other

Nusrat S, Levinthal D, Bielefeldt K.
Hospitalization rates and discharge status in multiple sclerosis.
Mult Scler Int. 2013;2013:436929.
abstract
Read the full text of this paper

Duchi S, Ovadia H, Touitou E., et al.
Nasal administration of drugs as a new non-invasive strategy for efficient treatment of multiple sclerosis.
J Neuroimmunol. 2013 May 15;258(1-2):32-40.
abstract

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