When multiple sclerosis (MS) symptoms intensify, worsening anxiety and discomfort can make it hard to tell if you need to take immediate action for a serious situation or if you’re just having a bad day. An MS relapse — also called a flare-up, attack, or exacerbation — doesn’t usually require a hospital visit. However, it’s important to be able to recognize when a relapse is an emergency.

MyMSTeam members have often expressed concern about when they should go to the hospital. “When do you go to the emergency room for a relapse? Feeling horrible,” wrote a MyMSTeam member.

Another member said, “I am having more days of wanting to go to the emergency room. Always in pain — I don’t know what to do!”

MS is a disease of the central nervous system (CNS). In MS, the immune system doesn’t work right and mistakenly attacks the body’s nerve fibers. Then, the nerves don’t function properly, and lesions — or scars — form on the brain, spinal cord, or optic nerves.

Common symptoms of MS include:

• Difficulties with motor function
• Vision impairment or partial vision loss
• Cognitive dysfunction (difficulty with thinking and memory)
• Fatigue
• Muscle spasms
• Numbness
• Tingling
• Problems with bladder or bowel function

Most types of MS are characterized by relapses when existing symptoms get worse and new symptoms may appear.

Debilitating fatigue, weakness, and other symptoms can affect your quality of life, but they may not indicate a multiple sclerosis relapse. Understanding more about which symptoms suggest a relapse can help you recognize when you might need emergency medical care.

What Is an MS Relapse?

A relapse refers to a period of worsening MS symptoms or the onset of new ones that last more than 24 hours and occur at least 30 days after a previous flare-up. Relapses occur when inflammation (not caused by infection) causes new lesions to form due to damage to myelin, the protective coating on nerves.

Typically, a relapse develops over 24 to 48 hours and reaches its full severity within several days. The frequency and severity of relapses vary among people with MS.

In relapsing-remitting MS (RRMS) — the most common type of MS — a relapse can last days, weeks, or even months. Then, during remission, symptoms calm down or go away entirely. Relapses can also occur in secondary progressive MS (SPMS), in which disability from MS gradually gets worse, rather than going into remission. If you've had a past episode of clinically isolated syndrome (CIS) — a nerve disorder related to MS — and then a relapse, you should contact your doctor about being tested for MS.

Primary progressive MS (PPMS) worsens over time without relapses.

How To Know When a Relapse Is an Emergency

If your new or worsening symptoms last more than 24 hours, you should first discuss them with your neurologist. If you can’t reach your doctor directly, speak to a nurse or a physician assistant. In many cases, a relapse may be characterized by mild symptoms, such as tingling or numbness, that don’t need treatment. You may also experience more severe symptoms that can be treated outside of a hospital.

Symptoms are considered serious and in need of hospital treatment if they prevent you from eating or drinking, caring for yourself, or walking. Symptoms of a severe relapse that may require hospitalization include:

• Disabling pain
• Optic neuritis that impairs vision
• Inability to move or maintain balance
• Bladder problems
• Dizziness

One MyMSTeam member wrote, “I’m back in the hospital. Second attack of the year that’s landed me in hospital after nine years of no stays. Frustrated — paralysis, spasticity, legs just plum don’t work.”

Another member shared their experience: “I started getting vertigo. It kept on getting worse. Then I probably got sicker than I ever have. Finally, I got too weak to walk. Long story short, I was admitted to the hospital.”

Always get medical advice, if possible, before going to the hospital for a relapse. An unnecessary trip to the emergency department can be expensive, time-consuming, and uncomfortable, with long waits. “Ugh. Sitting in the emergency room for two hours now. My neurologist wants MRIs — thinks I’m relapsing again. My whole body hurts😔🤕,” a member said.

If you experience severe neurological symptoms but can’t reach your health care provider directly, let your doctor know as soon as possible that you’re seeking emergency care.

Pseudo-Relapses or Fluctuations

MS symptoms can also intensify during pseudo-relapses, also known as pseudo-exacerbations or fluctuations. Pseudo-relapses can be caused by:

• Viral or bacterial infection
• Strenuous exercise
• Emotional stress
• New medication
• Depression
• Overheating or overexertion

A pseudo-relapse usually occurs without clinical progression of MS and resolves within 24 hours. In one study, researchers noted that people experiencing pseudo-relapses who go to emergency departments don’t usually need to be hospitalized for treatment. For example, if a pseudo-relapse is caused by an infection, treating the underlying problem will likely improve MS symptoms.

If you’re taking natalizumab (Tysabri) to treat your MS, you should immediately report any worsening symptoms to your doctor. These could be side effects that increase your risk of a rare but serious brain infection. Your doctor can advise you on what to do, such as getting emergency care.

What To Expect if You Go to the Hospital

Depending on the severity of your relapse, your doctor will determine if a hospital stay is the best option. Your relapse symptoms might require high-dose, fast-acting steroids, which can sometimes be given outside the hospital. Your doctor might also order a magnetic resonance imaging (MRI) scan.

High-Dose Steroids

If you’re having a sudden flare-up that needs treatment, you may be admitted to the hospital for an IV infusion of short-term high-dose corticosteroids, such as intravenous methylprednisolone (Solu-Medrol) or oral prednisone. Corticosteroids are the most common option to treat MS relapses that are severe. Steroid treatment can quickly reduce inflammation and help prevent permanent damage, such as vision loss. A course of high-dose steroids typically takes three to five days.

Corticosteroids can have side effects, including:

• Increased risk of osteoporosis (thinning of bones)
• Disruption of metabolic and endocrine (hormonal) functions
• Stomach acidity or acid reflux
• Infection

Because of these risks, corticosteroids are given short-term only for serious MS relapses. People who can’t tolerate steroids may receive another type of treatment, such as plasmapheresis (plasma exchange) or injections of repository corticotropin hormone (Acthar Gel).

A MyMSTeam member described their experience with steroids. “My whole left side has shut down. So I’m going into the hospital tomorrow for a seven-day course of steroids,” they said. “The steroids have to be done intravenously because taking them orally, I just throw them back up. I suffer from bad stomach cramps. So, the hospital is the only way to go.”

Outpatient Options

Corticosteroid infusions can also be given at an infusion center or even at home. People who can tolerate oral steroids or improve with a steroid injection by syringe may not need an IV infusion during a relapse.

Even if you’re experiencing a difficult relapse, your doctor may initially recommend that you seek treatment outside of a hospital. As one team member described: “My flare-up is very bad — legs and arms feel like lead weights, and walking is very difficult right now. Intense tingling and spasms. Fatigue is insane. Had a steroid injection today and will have another one on Monday. Have an emergency appointment with a neurologist next week. I may need to go to the hospital for IV steroids.”

MRI Testing

Before administering high-dose steroids, your doctor may recommend an MRI to evaluate disease activity or confirm that a relapse has occurred.

One MyMSTeam member described how their symptoms led to an MRI. “Having a bad day and took a trip to the emergency room for severe leg and calf spasticity,” they said. “I can’t stand or walk. My leg muscles won’t loosen up. Just finished up with another MRI and waiting on results.”

Another member wrote about their hospital stay: “My MRI was actually good news to me. They said there were no new lesions, and lesions from the previous MRI appear improved or are smaller than the prior examination 😊. But still didn’t explain why I’m off-balance with terrible headaches and spine pain. So that got me admitted overnight for observations 😒.”

Keep All Your Doctors Informed

Let your neurologist know right away if you go to the hospital because of worsening MS symptoms. While there, tell the emergency room doctor about your MS, symptoms, and treatments, and answer all their questions as best you can. Good communication and shared decision-making are key to getting the highest-quality care if you go to the hospital for an MS relapse.

Review Your Treatment With Your Doctor if Relapses Are Worsening

If your relapses are becoming more frequent, or if you’re visiting the emergency room or are hospitalized more often, it may be time to review your MS care and treatment plan with your doctor. Treatment options for relapsing forms of MS have expanded considerably in recent years, and you may benefit from a follow-up appointment to review your treatment plan with your neurologist.

If you’ve relapsed six to 12 months after a prior relapse or if you’ve had even a mild relapse within the first year of MS treatment, it’s important to talk to your doctor about your treatment plan.

Disease activity and disease progression in relapsing MS are treated with several different disease-modifying therapies (DMTs). DMTs are taken orally, by injection, and by intravenous infusion. They include these medications among many others:

• Alemtuzumab (Lemtrada)
• Cladribine (Mavenclad)
• Monomethyl fumarate (Bafiertam)
• Ofatumumab (Kesimpta)

Some treatment options may be available in clinical trials if you qualify. With any new medication, be sure to discuss potential side effects with your doctor so that you understand the potential risks and benefits of a new treatment option.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 208,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Do you have questions about relapses and hospitalization? Have you been hospitalized with a relapse? Share your experience in the comments below, or start a conversation by posting on your Activities page.