Multiple sclerosis (MS) is usually characterized by three phases: relapse, remission and progression. During a relapse — sometimes referred to as a flare-up, exacerbation, or attack — disease activity causes new lesions to form in the central nervous system (CNS), symptoms may worsen, or new symptoms may develop. In periods of remission, symptoms of MS may partially or completely disappear.

Relapsing-remitting multiple sclerosis (RRMS) is the most common type of MS Clinically isolated syndrome (CIS) and secondary progressive MS (SPMS) are other types of MS or patterns of the disease, and can also involve relapses. Primary progressive MS (PPMS) is a form of MS that gradually worsens without relapses.

Although there is no cure for MS, treatment, rehabilitation, and lifestyle changes can help manage symptoms, achieve and maintain remission for as long as possible, and improve quality of life. Here are some things to know about achieving remission that you can discuss in more detail with your neurologist and health care team.

Understanding Relapse and Remission

MS is an autoimmune disease of the central nervous system in which the immune system attacks healthy nerve fiber. When this happens, lesions form in the central nervous system, including the brain, spinal cord, or optic nerve. Nerve damage can cause relapses with a range of acute symptoms, such as fatigue, nerve pain or tingling, balance and motor problems, muscle spasms, and cognitive difficulties. Symptoms of relapses can vary considerably among people with MS.

The onset of acute symptoms in MS is a sign of active disease or relapse. In each type of MS, new lesions damage the myelin sheath that coats nerve fibers. Despite nerve damage from MS, in some cases MS symptoms may completely resolve.

However, MS is a progressive disease, meaning symptoms can often worsen over time and cause lasting disability. New symptoms can also appear during an MS relapse and may indicate worsening disease. If acute symptoms last 24 hours or more, they are usually considered a relapse. A relapse can last anywhere from a few days to several months, depending on the severity.

During periods of remission or recovery, disease activity calms down and symptoms are either less intense or not apparent at all. The time frame of remission varies from person to person. On average, periods of remission can last for months or even years until another relapse occurs.

Clinically Isolated Syndrome

The first time someone experiences a neurological attack with symptoms that resemble MS, it’s called clinically isolated syndrome (CIS). Doctors usually investigate for signs of previous attacks in people with CIS and sometimes make an MS diagnosis based on their findings. If a doctor determines a person’s CIS is not MS, the person still remains at risk for developing it. About 63 percent of people who experience CIS — particularly if brain lesions are detected on an MRI scan — develop MS. Those with CIS who have little to no lesions on their scans have about a 20 percent risk of developing MS, according to the MS Society.

Relapsing Remitting MS

Approximately 85 percent of people with MS have a diagnosis of relapsing remitting MS. RRMS develops most often in people in their 20s and 30s. It’s two to three times more common in women than men. People with RRMS will experience relapses that are followed by periods of remission. During remission, symptoms will recede — either partially or completely — and disability will not actively progress. But with subsequent relapses, the disease will likely worsen and disability will increase.

Secondary Progressive MS

Many people who have RRMS transition into secondary progressive MS, typically 10 to 25 years after their initial RRMS diagnosis, according to the National Multiple Sclerosis Society. In people with SPMS, relapses may decrease or even stop. SPMS is then characterized by gradual and ongoing disease progression with disability that gets worse over time.

Because SPMS causes increasing disability, it doesn’t technically go into remission. In these cases, treatment is mainly focused on managing symptoms. Disease-modifying treatments (DMTs) are of limited use.

New Perspectives on Achieving Remission With MS

MS treatment has evolved considerably in recent years with the development of highly effective disease-modifying therapies, also known as disease-modifying drugs (DMDs). These powerful medications have had a significant impact in reducing inflammation, thereby slowing disease progression and the onset of disability. New drugs continue to be developed in clinical trials in an effort to treat MS more effectively and reduce side effects.

Although the term “remission” is commonly used in the characterization of MS, medical researchers are also recognizing that MS likely continues to have a silent progression even during times when symptoms are alleviated after relapses. With this in mind, early treatment with DMTs is increasingly seen as the gold standard in reducing relapses and disease progression. Meanwhile, researchers are working on better tools and methods for measuring disease activity and degrees of remission in MS.

Disease-modifying therapies have been shown to reduce the frequency and number of relapses, decrease damage to nerves, and may help reduce disability and permanent damage to the nervous system. DMTs help achieve and prolong remission so that people with MS can have a more active and healthy quality of life.

Some of the approximately 20 DMTs approved to treat MS include:

• Cladribine (Mavenclad)
• Diroximel fumarate (Vumerity)
• Glatiramer acetate (Copaxone)
• Ocrelizumab (Ocrevus)
• Teriflunomide (Aubagio)

Ask your doctor about potential side effects of DMTs and which one is likely to be safest and most effective for you.

Other Factors in Achieving and Sustaining Remission

Along with maintaining your treatment plan, other strategies — discussed below — may help you maintain remission.

Undergoing Rehabilitation Therapy for MS

Specialized rehabilitation therapy can reduce the condition and dysfunction in people living with MS. Rehabilitation that is targeted to an individual’s specific needs may include:

• Exercise
• Occupational therapy
• Speech therapy
• Cognitive and psychological rehabilitation
• Training to improve daily functioning

Avoiding MS Triggers

Certain habits, stress, and heat are some of the triggers associated with MS relapses. You can extend periods of remission by paying attention to triggers that may worsen your MS, then avoiding them.

Smoking and alcohol are triggers that can aggravate MS. Alcohol may make some symptoms worse. Smoking is the main modifiable factor associated with a greater risk of progressive MS and disability. Talk to your doctor if you need help to quit smoking. Smoking may also reduce the effectiveness of medication used in the treatment of MS.

Heat can also make symptoms worse temporarily during periods of remission. Try to gauge your heat sensitivity and avoid situations that may trigger symptoms, such as hot baths or showers. Swimming in cool water, drinking cool beverages, and staying in air-conditioned places during hot weather can help you avoid heat-triggered problems with MS. Cooling garments such as vests, jackets, and scarves are also available.

Stress and lack of sleep can trigger MS symptoms and possibly lead to a relapse. Practicing relaxation techniques such as meditation, yoga, and deep-breathing techniques can help reduce levels of stress and increase emotional and psychological well-being.

Maintaining a Healthy Lifestyle

A well-balanced, nutritious diet and maintaining a healthy weight can help reduce the risk of relapse triggers. Eating fruits and vegetables and avoiding processed foods or those high in saturated fats can help reduce inflammation.

Rehabilitation therapy or a physical therapist can help you develop a regular exercise routine such as cardio (walking or swimming, for example) to maintain muscle strength, improve overall health, and boost your mood.

Stay up to date on your vaccinations and annual flu shot to avoid infections that may make your symptoms worse.

Trying Complementary Treatments

Some people with MS benefit from complementary or alternative treatment such as acupuncture, medical cannabis, massage, or reflexivity.

Some surveys of people living with MS have reported that acupuncture may help improve symptoms such as pain, numbness and tingling, spasticity, mood changes, and bowel and bladder problems.

Be sure to get medical advice before taking any dietary supplements in order to avoid unwanted side effects or bad interactions with medication.

Scheduling Follow-Up Visits With Your Doctor

If you’re living with multiple sclerosis, it’s important to schedule follow-up appointments with your doctor to discuss any changes in your MS symptoms and whether it’s time to consider other treatment options. Good communication with your health care team can help ensure that your treatment plan is helping you as much as possible to stay in remission longer.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 207,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

What’s the longest period of remission you’ve had from relapsing MS? What steps do you take to maintain remission? Share your experience in the comments below, or start a conversation by posting on your Activities page.