Treatment of Relapses


Multiple sclerosis
(MS) is a chronic progressive inflammatory demyelinating disease
affecting the central nervous system. The most common clinical type of
MS tends to follow a relapsing course, affecting the vast majority of
patients living with this disease. Relapses are a hallmark of MS, and
are often associated with significant functional impairment and
decreased quality of life. Although usually followed by a period of
remission, residual symptoms after MS relapses may persist and lead to
sustained disability. Adequate management of MS relapses is important,
as it may help to shorten and lessen the disability associated with
their course. Historically, treatment of MS relapse was the first
approach (and for a period of time, the only approach) to MS treatment
in general. Systemic corticosteroids and adrenocorticotropic hormone
(ACTH) have broad regulatory approval and remain the most established
and validated treatment options for MS relapse. Therapeutic mechanisms
of ACTH were previously associated (perhaps mistakenly) with only
corticotropic actions; however, recently the direct anti-inflammatory
effects and immunomodulatory activity of ACTH gel acting through
melanocortin pathways have been shown. Second-line treatments of
steroid-unresponsive MS relapses and a possible algorithm for MS relapse
management are also reviewed in this article.

Whilst this is taking the coals to Newcastle if you are a RRMSer, some of the readers are EAEers and what they forget when trying to translate their studies into treatments is that: (a) The first episode of EAE is not a relapse, which by definition requires a previous attack  and (b) active attacks are treated with steroids and not DMT, which are usually started when there is remission.

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  • MD it depends on how you define a relapse. A lot of neurologists consider old MRI lesions as being indicative of sub-clinical relapses. Therefore if someone presents with a CIS and has lesions on MRI that can't explain their current presentation, they are considered have had previous attacks. That is the majority of CISers.

    It is not uncommon when you push a CISer you come up with symptoms suggestive of a previous attack, but as the relapse was not documented you can't call it a definite attack.

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