Most people with multiple sclerosis (MS) know that this condition can cause flares, also referred to as relapses. During a relapse, disease activity causes new lesions to form in the central nervous system (CNS). When this happens, symptoms may worsen or new ones may develop. But after a relapse, you may also have periods of remission, when symptoms of MS 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 that may involve relapses. Primary progressive MS (PPMS) is a form of MS that gradually gets worse without relapses.

There’s no cure for MS, but treatment, rehabilitation, and lifestyle changes can help you manage symptoms. They can also allow you to achieve and maintain remission for as long as possible and improve your quality of life.

Here are some key points about achieving remission, experiencing symptoms, and navigating recovery. You can discuss these topics in more detail with your neurologist and healthcare team.

Understanding Relapse and Remission

MS is an autoimmune disease that affects the CNS. The condition occurs when the immune system attacks healthy nerve fibers, causing lesions to form in the brain, spinal cord, or optic nerve. MS is usually characterized by three phases: relapse, remission, and progression.

Nerve damage can cause MS relapses with a range of symptoms, including weakness, fatigue, numbness, nerve pain or tingling, balance problems, muscle spasms, and cognitive (thinking and memory) difficulties. Symptoms of relapses can vary among people with MS.

Symptoms that are new or worse can be a sign of active disease or relapse. In each type of MS, new lesions damage the myelin sheath that coats nerve fibers. Despite the nerve damage, MS symptoms may sometimes completely go away.

However, even relapsing forms of MS may progress over time. This means some symptoms may worsen and become permanent. New symptoms can also appear during an MS relapse. Acute symptoms lasting 24 hours or more without another known cause are usually considered a relapse. A relapse can last anywhere from a few days to several months, depending on the severity.

Recovery From an MS Relapse

As an MS relapse fades and you enter remission, your symptoms may ease. However, some people still feel very tired. If you notice lingering fatigue or other symptoms, give yourself time to rest and recover.

Don’t hesitate to ask for help with daily tasks like cooking, cleaning, and child care. If needed, talk to your employer about taking time off or working from home. If your relapse included new symptoms that kept you from being active, your muscles might feel weak. You might need to work with a physical therapist to help you regain strength safely.

What Happens to MS Symptoms During Remission?

During periods of remission or recovery, disease activity calms down and symptoms are either less intense or not apparent. 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. Relapse may sometimes be referred to as a flare-up, exacerbation, or attack.

MyMSTeam members have described their experiences with the symptoms and time frames of MS remission:

• “In remission, but with headaches, dizziness, and weakness at times — no numbness, thank God.”
• “After my diagnosis, I was in remission for 20 years. As I get older, the condition has become much more obvious.”
• “I’m in a remission — I’ve got the usual aches but no major spasms.”
• “In 2014, I went into a remission that has not ended. I just had my 10th anniversary of my remission.”
• “When I was having exacerbations and remissions, there was nothing regular or predictable about how long it would take to get back into remission.”
• “I’ve been in remission for eight years, so I don’t experience any symptoms anymore.”

Because the length of MS remission varies widely, it’s important to talk with your doctor. They can advise you on whether you’re in remission and how to manage symptoms if you’re in a relapse.

MS Types and Remission

Not every type of MS involves periods of relapse and remission. If you’ve been diagnosed with one of the conditions below, you may experience periods of remission.

Clinically Isolated Syndrome

A person’s first neurological attack with symptoms that resemble MS is called clinically isolated syndrome. Doctors usually look for signs of previous attacks and sometimes make an MS diagnosis based on their findings. If a doctor determines that a person’s CIS is not MS or another condition, the person may remain at risk of developing MS.

Sixty percent to 80 percent of people who have CIS and whose MRI scans show brain lesions typical of MS will develop MS. Those whose scans don’t show brain lesions have about a 20 percent risk of developing MS, according to the National Multiple Sclerosis Society.

Relapsing-Remitting MS

Approximately 85 percent of people with MS are diagnosed with relapsing-remitting MS. RRMS develops most often in people in their 20s and 30s. This type is two to three times more common in women than men. People with RRMS will experience relapses that are followed by periods of remission, according to the Multiple Sclerosis Trust. During remission, symptoms will ease — either partially or completely — and disability won’t actively progress. But with more relapses and with time, the disease may worsen and disability will increase.

Secondary Progressive MS

Some people who have RRMS transition into secondary progressive MS. In those with SPMS, relapses may decrease or even stop. SPMS is then characterized by gradual and ongoing disease progression with disability, worsening over time.

Because SPMS leads to increasing disability, it is not considered to go into remission. Treatment focuses mainly on managing symptoms. Disease-modifying therapies (DMTs) may be an option at this stage. Talk to your neurology team about which SPMS treatments may be right for you.

New Perspectives on Achieving Remission With MS

In recent years, MS treatment has evolved considerably with the development of highly effective DMTs, also known as disease-modifying drugs. These powerful medications significantly reduce inflammation, slowing disease progression and delaying disability. New drugs continue to be developed in clinical trials to treat MS more effectively and reduce side effects.

Doctors often use the term “remission” when characterizing MS, but research suggests that a silent progression likely continues, even when symptoms improve after a relapse. Because of this, early treatment with DMTs is increasingly seen as the gold standard in reducing relapses and slowing disease progression. Researchers are also developing better tools and methods to track disease activity and measure remission.

DMTs have been shown to lower the frequency and number of relapses and reduce nerve damage. These medications may also help slow disability and protect the nervous system from long-term damage. By helping to extend remission, DMTs support a more active and healthy life for people with MS. However, so far, no current medication fully stops the progression of the disease.

The U.S. Food and Drug Administration (FDA) has approved more than 20 DMTs to treat MS. Examples include:

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

Ask your doctor about these drugs’ potential side effects and which DMT is likely to be the safest and most effective for you.

Other Factors in Achieving and Sustaining Remission

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

Undergoing Rehabilitation Therapy for MS

Specialized rehabilitation therapy can help improve function and quality of life for people with MS. Rehabilitation that’s targeted to specific needs may include:

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

Avoiding MS Triggers

Certain habits, exposure to heat, and lack of sleep are linked to fluctuations in MS symptoms. You can avoid some worsening of symptoms by paying attention to — and then avoiding — triggers.

Smoking and alcohol can worsen MS. Alcohol may make some symptoms worse, while smoking is associated with faster MS progression and greater disability. Smoking may also make some MS medications less effective. If you need help quitting, talk to your doctor.

Heat can also make symptoms temporarily worse 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 chilled 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.

Sleep issues are common among people with MS, but lack of sleep can trigger symptoms. Practicing good sleep habits, such as going to bed at the same time every night, avoiding caffeine, and keeping your bedroom cool and quiet, may help.

Maintaining a Healthy Lifestyle

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

A rehabilitation or physical therapist can help you develop a regular exercise routine, like walking or swimming, to maintain muscle strength, improve overall health, and boost your mood.

Keep up with your vaccinations and annual flu shot to help prevent infections that could make your MS symptoms worse. Always check with your doctor before getting a vaccine, as some may not be recommended if you’re on a specific DMT.

Exploring Complementary Treatments

Some people with MS benefit from complementary or alternative treatments such as acupuncture, medical cannabis, massage, or reflexology. For example, acupuncture may help improve some common symptoms of MS, such as pain, numbness and tingling, spasticity, mood changes, and bowel and bladder problems.

Check with your doctor before starting any dietary supplements to prevent side effects or interactions with your medication.

Scheduling Follow-Up Visits With Your Doctor

If you’re living with MS, schedule regular checkups with your doctor to track changes in your MS symptoms and explore other treatment options if needed. Good communication with your healthcare provider can help ensure that your treatment plan is working to keep you in remission as long as possible.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 218,000 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 time you’ve been in remission from relapsing MS? What steps do you take to stay in remission? Share your experience in the comments below, or start a conversation by posting on your Activities page.