How to Prevent MS Flare-Ups

 

To try to prevent a flare-up from happening:

Take meds as directed. The drugs your doctor prescribes help slow your MS from getting worse and help prevent relapses. If you have side effects, don't just stop taking them. One study found about 25% of MS patients who stopped taking their meds had a relapse. Certain meds for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions. Check with your doctor to see if there are meds you’re taking that could be interacting with one another, and if your current meds are right for you. 

Stay healthy. A bout of cold or flu can set off your MS symptoms. A bladder infection can trigger either a flare or a pseudo-flare, so the same advice applies. In fact, infections cause a third of MS flare-ups. Wash your hands with warm water and soap during the day, get your yearly flu shot, and avoid people who look sick. Stay hydrated. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.Ask your doctor for other ways to avoid bladder infections, including vaccinations. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.

Relax. In some people with MS, stress can bring on flare-ups. Find calmness with meditation, yoga, counseling, or anything else that's good for you and helps you unwind. In one study, MS patients reported their stress level was cut nearly in half after 6 weeks of yoga.

Rest. You won't feel well when you're worn out. Sleep problems are common in people with MS. Symptoms like pain and muscle spasms can keep you up at night. Some of the meds that treat MS interrupt sleep, too. Work with your doctor to get your symptoms under control so you can sleep. Adjust your meds if they keep you awake. Aim for 7 to 8 hours of sleep per night.

Stay cool. High temps may trigger a flare-up. If you’re affected negatively by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days. Take cool baths and/or run air conditioning. Try a hat or clothes that hold ice packs or frozen gel packs to stay comfortable. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.

Eat well. Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats. A healthy diet helps keep your immune system strong.

Steer clear of smoking. This is a major risk factor for flare-ups, and it can make your symptoms worse. If you smoke, your doctor can help you make a plan to stop.

From: WebMD

New Research Shows Link Between Sleep and Thinking Problems in People with MS

 A recent study showed that sleep problems and thinking (cognitive) problems occurred significantly more frequently in nurses with MS than in nurses who didn’t have MS, and these issues were linked. This means that sleep problems, which are common in MS, may be a factor in the development of cognitive problems. Sleep disorders are treatable (see below). Whether improving sleep can improve cognitive function as well has yet to be determined.

• Background: Sleep difficulties are more common in people with MS than in the general population. In addition, many people with MS develop problems with cognitive function, including information processing and memory. A team from the University of Michigan investigated whether sleep problems contribute to cognitive problems in people with MS.
• This Study: Investigators looked at questionnaires completed by 63,866 nurses (524 of with MS) enrolled in the Nurses’ Health Study. This ongoing study uses questionnaires to track chronic conditions and risk factors for chronic conditions in women nurses. Participants had been asked about diagnosed/suspected sleep disorders and daytime sleepiness. They also had been asked whether they had difficulties with memory, or with cognitive tasks such as following instructions or navigating familiar streets.
• Results: Sleep disorders, sleepiness, and cognitive problems were significantly more common in nurses with MS than in those without MS. Using advanced statistical methods, the group showed that the occurrence of sleep disorders and sleepiness were significantly associated with the development of cognitive impairment.
• The Meaning: Sleep problems and cognitive problems affect many people with MS. This study shows a possible connection, meaning that sleep disorders or excessive sleepiness may be leading to cognitive problems. Further study can help to determine if this is the case. This is important because sleep disorders are treatable. Research in people who do not have MS is starting to show that treatment for some sleep disorders may improve cognition, so there is hope that this may also be true for people living with MS.

Learn more…
Are you sleep deprived? Learn more
Get 6 strategies to improve your sleep
Watch a webinar - Ask an MS Expert: Sleep and MS
 
“Pathways between multiple sclerosis, sleep disorders, and cognitive function: Longitudinal
findings from The Nurses’ Health Study,” by Tiffany J Braley , Monica M Shieu, Afsara B. Zaheed and Galit Levi Dunietz, is published in the MS Journal (published online January 12, 2023),
 

Genetic Predisposition in MS

Genetic predisposition alone does not lead to MS

Studies in recent years have clearly shown that genetic risk variants are a necessary condition for developing multiple sclerosis. "Based on our study, we were able to show that about half of the composition of our immune system is determined by genetics," says Florian Ingelfinger, a PhD candidate at the UZH Institute of Experimental Immunology. The study by the team led by immunologist Burkhard Becher, professor at the Institute of Experimental Immunology at UZH, and the research groups of Lisa Ann Gerdes and Eduardo Beltrán of the Institute of Clinical Neuroimmunology at the LMU Klinikum, shows that these genetic influences, while always present in MS patients, are not on their own sufficient to trigger multiple sclerosis. In the study, 61 pairs of monozygotic twins where one twin is affected by MS whereas the co-twin is healthy were examined. From a genetic point of view, the twins were thus identical. "Although the healthy twins also had the maximum genetic risk for MS, they showed no clinical signs of the disease," says Lisa Ann Gerdes.

Twin study eliminates genetic influences

Thanks to this globally unique cohort of identical twins, the researchers were able to exclude genetic influences by comparing twins with and without multiple sclerosis. "We are exploring the central question of how the immune system of two genetically identical individuals leads to significant inflammation and massive nerve damage in one case, and no damage at all in the other," explains Burkhard Becher. Using identical twins enabled the international team of scientists to rule out the genetic influence and specifically track the immune system changes that were ultimately responsible for triggering MS in one twin.

Cutting-edge single-cell technologies and artificial intelligence

The researchers harness state-of-the-art technologies to describe the immune profiles of the twin pairs in rich detail. "We use a combination of mass cytometry and the latest methods in genetics paired with machine learning to not only identify characteristic proteins in the immune cells of the sick twin in each case, but also to decode the totality of all the genes that are switched on in these cells," Florian Ingelfinger explains. Eduardo Beltrán, an expert in single-cell genomics, adds: "This ensures that we obtain as much information as currently technically possible from these valuable samples." The team uses a variety of tailored algorithms based on artificial intelligence to extract relevant insights from this immense dataset.

An error in the communication of immune cells

"Surprisingly, we found the biggest differences in the immune profiles of MS affected twins in to be in the cytokine receptors, i.e. the way immune cells communicate with one another. The cytokine network is like the language of the immune system," says Ingelfinger. The researchers found that increased sensitivity to certain cytokines leads to greater activation of T cells in the blood of patients with multiple sclerosis. These T cells are more likely to migrate into the central nervous system of patients and cause damage there. The identified cells were found to have the characteristics of recently activated cells, which were in the process of developing into fully functional T cells. "We may have discovered the cellular big bang of MS here -- precursor cells that give rise to disease-causing T cells," says Becher.

Important foundation for understanding the influence of genetics and environment on MS

"The findings of this study are particularly valuable in comparison to previous studies of MS which do not control for genetic predisposition," says Burkhard Becher. "We are thus able to find out which part of the immune dysfunction in MS is influenced by genetic components and which by environmental factors. This is of fundamental importance in understanding the development of the disease." The participating twins were recruited for the study at the LMU Klinikum. "This unique opportunity to unravel the influence of genetics and environment in multiple sclerosis is entirely thanks to our patients who agreed to join the study," said Lisa Ann Gerdes.

University of Zurich. “Multiple sclerosis: Study with twins untangles environmental and genetic influences.” ScienceDaily. ScienceDaily, 16 February 2022. www.sciencedaily.com/releases/2022/02/220216112303.htm

What Causes an MS Flare-Up?

What triggers a flare-up is different from person to person. Most of the time, a cause cannot be found. Still, to lower your chance of a flare-up, do your best to avoid the things that make them more likely for you:

Stress

It’s a part of life, but doing what you can to manage it can lower your chance of a relapse. Meditation, yoga, and counseling are all ways to lower stress and better equip yourself to handle it. In one study, MS patients reported their stress level cut nearly in half after 6 weeks of yoga.

Fatigue

Lack of sleep can bring a flare-up. Making sleep a priority will help lower your chance of symptoms. Try to get 7-8 hours each night.

Heat

High temperatures may trigger a relapse. If you’re one of those people affected by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days.

A cool bath and air conditioning are two things that can help. Special hats or clothes that hold ice packs or frozen gel packs can also keep you comfortable. There are also special vests that use a motorized system to circulate cold water around the body. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.

Infections

They cause a third of MS flare-ups. To lower your risk:

Wash your hands.

Do what you can to avoid people who are ill.

Make sure food you eat is fully cooked.

Practice safe sex.

Get your annual flu shot.

Even minor infections like the cold or flu can trigger a flare-up.

If you have an infection, treat it early.

Diet

Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats.

A healthy diet helps keep your immune system strong.

Medications

Skipping your MS medicine can increase your risk for a flare-up. One study found about 25% of MS patients who stopped taking their medications suffered a relapse. Certain medications for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions.

Check with your doctor to see if there are medications you’re taking that could be interacting with one another.

Smoking

Smoking is a major risk factor for flare-ups. Stop and you’ll lower your chances of them. Your doctor can help you figure out a game plan.

 

 https://www.webmd.com/multiple-sclerosis/ms-flare-causes?ecd=wnl_mls_122322&ctr=wnl-mls-122322_lead_cta&mb=q80%2F%40kIeuyYKtyaYzOxdbc6RVoMqf%400VkpmvpK5yEEQ%3D

 

 

 

New Advances in MS Treatment

Disease-modifying therapies (DMTs) can help decrease your MS symptoms. The FDA has approved new ones to treat and manage MS:

• Diroximel fumarate (Vumerity) lessens inflammation and stops nerve damage that may cause MS symptoms.
• Fingolimod (Gilenya) reduces the MS relapse rate in adults and children. It’s the first FDA-approved MS drug for kids. 
• Ofatumumab (Kesimpta) is an injectable drug that can prevent MS symptoms from coming back and slow down disability in people with MS.

 More disease-modifying therapies (DMTs) the FDA has approved to treat and manage MS:

• Ozanimod (Zeposia) can help with clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS. 
• Ponesimod (Ponvory) can lower MS symptoms coming back by more than 30%.
• Siponimod (Mayzent) and cladribine (Mavenclad) are other MS treatments that can lower your relapse rate if you have MS. They stop certain cells of the immune system from causing nerve damage.
  
  

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Symptoms of Relapsing-Remitting MS

 

No two people with MS are likely to have the same symptoms in the same way. Some may come and go or appear once and not again. The symptoms you have depend on the area of your brain or spinal cord that the disease has damaged. They can include:

• Eye pain and vision problems such as double vision or jumpy vision. These problems may be the first sign you have RRMS.
• Numbness and tingling
• Sensitivity to heat
• Pain that runs down the spine, like a mild electrical shock, when you bend your neck
• Dizziness
• Bowel or bladder problems
• Sexual problems, like trouble getting aroused or climaxing
• Stiff muscles and trouble moving your body
• Feeling weak and tired
• Problems with balance and coordination
• A hard time thinking clearly
• Depression

An RRMS attack can last anywhere from 24 hours to several weeks. It can involve:

• One or many symptoms
• An existing problem that gets worse
• A new symptom

Tell your doctor about signs of a relapse as soon as possible. If you treat it quickly, you might be able to reduce lasting damage and disability.

Chronic Itching May Be Overlooked in MS

Researchers at the University of Miami found that 27 of 77 people with MS reported experiencing chronic itching (also known as pruritus). Itching occurred in the upper and lower limbs and hands, scalp, and face. Compared to people with MS without chronic itching, people with it reported more fatigue, heat sensitivity, cognitive impairment, and depression or anxiety. They also were more likely to have nervous tissue damage in the spinal cord or brainstem (the base of the brain).

Some Treatments Help: Importantly, note the authors, chronic itching in MS is most likely “neuropathic” – meaning it is likely occurring from “short-circuiting” of the nerves that carry signals from the brain to the body because of damage from MS. For this reason, topical itch relief, such as skin creams, are not likely to help. But this type of chronic itch is similar to neuropathic pain, and may respond to nonpharmacologic (acupuncture, mindfulness and meditation, cognitive behavioral therapy) or pharmacologic (anti-seizure medications, anti-depressant medications) treatments. Heat was noted as an aggravating factor in this study, so wrapped ice packs might help as well.

Learn more about pain and itching and treatment in MS, and get a handle on new approaches to relieving neuropathic pain, which may help chronic itching

Read more about this study from University of Miami Health

Read a scientific summary of the study (abstract) in The Journal of the European Academy of
Dermatology and Venereology