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13 Truths About Pseudo-Exacerbations

By Gay Falkowski

The word ‘pseudo’ is often used to describe something fake. However, the discomfort and pain of a pseudo-exacerbation (also known as a pseudo-relapse) is very real and can be alarming to the person with multiple sclerosis who worries that a sudden worsening of symptoms may be a sign of disease progression. Here’s some useful information to help you learn the difference between a pseudo-exacerbation and a real one, along with what you might be asked to do to help your doctor asses your condition if you experience a symptom flare:
1) A true exacerbation results from a new MS lesion in the brain or spinal cord. A pseudo-exacerbation is a worsening of symptoms in the setting of an external complicating factor that is not related to an actual new lesion from your MS.
2) A true exacerbation lasts more than 24 hours and happens at least 30 days after any previous relapses. Symptoms of a pseudo-exacerbation often resolve within 24 hours.
3) Some potential causes of a pseudo-exacerbation include infections (viral or bacterial), elevated core body temperature (related to exercise activity or the environment), new medications, physical overactivity, and stress.
4) Pseudo-exacerbation symptoms often involve many different systems and body parts. The following are more common pseudo-exacerbation symptoms:
5) Evaluation of both exacerbations and pseudo-exacerbations is important, so when you suspect an exacerbation or pseudo-exacerbation is occurring, contact your doctor and be prepared to answer some questions about your health.
6) If you’re able, take time to review your recent health and make note of any infections, new medications, and any other recent activity or changes that might be relevant.
7) Note any changes in urinary bladder control or the clarity or odor of your urine. Also, record the dates of mild respiratory or gastrointestinal infections, if you’ve had any.
8) Take your temperature. When you call your doctor, you will probably be asked if you’ve been running a temperature.
9) In some cases, your doctor may order a chest x-ray or advise you to visit with your family doctor to look for other issues.
10) Blood levels may be checked if you are on a medication that may aggravate MS symptoms. If you are on an interferon beta-type medication (Betaseron, Avonex, Rebif, Extavia) or natalizumab (Tysabri), you may take a blood test for antibodies that interfere with the medication’s effectiveness.
11) If you are on natalizumab (Tysabri), any worsening should be immediately communicated to your doctor, as it could represent the brain infection commonly known as PML.
12) Be prepared to let your doctor know if you’ve have had any recent MRI scans and, if so, when and where. Your doctor may request an MRI scan of the appropriate region to evaluate for a true exacerbation. The type of symptoms you are experiencing will determine what type of MRI scan that you will take.
13) While steroids may speed recovery from true exacerbations, they are not usually used to treat pseudo-exacerbations. A pseudo-exacerbation is treated by removing the cause, placing the body in a recovery environment, and allowing symptoms to subside on their own.