By
Devin
Garlit ·
Exacerbation, relapse, flare-up,
attack: these are all names for the same thing with regard to Multiple
Sclerosis. The general definition of this event is the occurrence of new
or worsening of old symptoms lasting for more than 24 hours and taking place at
least 30 days after a similar event. While this can be standard occurrence
for those with Multiple Sclerosis, not everyone actually understands what’s
going during this period. Understanding what is happening during an
exacerbation is critical for those with MS. With that in mind, I’ll do my best
to help break it down as simply as I can.
What’s happening to
the body during an MS exacerbation?
During one of these moments, the
disease has caused your own immune
system to attack your body. Specifically, your immune system begins to assault
your central nervous system. Its weapon of choice? Inflammation (caused by
various immune cells). This inflammation damages myelin, a fatty
substance that surrounds and helps insulate our nerves. This insulating layer
makes sure our nerves properly conduct the electrical signals that our brain
sends to the other parts of our body (think of it as the plastic covering on an
electrical wire). When this layer is damaged, those signals don’t move fast
enough or at all, which is where we start to see our symptoms. Can’t lift your leg fast enough or at
all? The myelin around a nerve between your brain and leg has been compromised
and the signal isn’t traveling as efficiently as it should be. Not only
does our immune system damage the myelin, but it also damages the cells needed
to regrow it.
When the immune system attacks
These
moments that we call exacerbations (or whichever term you like) are when the
immune system is making its attack. It’s when the immune system has created a
lot of inflammation in your central nervous system, and it’s damaging that
myelin layer. Not only does this inflammation damage that protective
coating, but it also has an effect on those signals that are traveling through
that part of the central nervous system. We use steroids to fight exacerbations
as they help to reduce this inflammation.
When a relapse is
over: the aftermath
When
an exacerbation is over, these damaged areas of myelin develop some scar tissue
(that’s where we get the term sclerosis in multiple sclerosis, we are left with
multiple scars; these scars are also referred to as plaques or lesions). Once
all that inflammation is gone or significantly reduced, some of that myelin can
regrow, but it never grows back completely or strong enough due to the scarring
and because the cells needed to facilitate regrowth have been damaged. This
regrowth, coupled with the reduction in inflammation, is why people can seem to
bounce back after an exacerbation. They may even seem like they are completely
well again. That’s why people often use the term “relapse,” because they seem
to improve or go back to the way they were. This is a pattern that is extremely
common in people diagnosed with the Relapsing-Remitting form of the
disease. However, the more exacerbations you have, the more your ability
to bounce back becomes hindered.
Accumulating damage
over time
The
more scars you have and the more cells that help regrow myelin are damaged, the
less you are able to recover. In the past, maybe a damaged nerve could
still get the brain’s signal where it needed to go, even if not the most
efficiently (unless an outside influence temporarily triggered an issue). As
more damage occurs over time though, the ability of that nerve to do its job,
no matter the situation, becomes compromised. Basically, that’s how people with
MS can worsen over time. That’s why doctors try to not only shorten the length
of exacerbations through steroids, but to minimize the overall number of them
with disease-modifying drugs.
