ultiple sclerosis (MS) is a neurological immune-mediated disease where the immune system erroneously attacks the central nervous system.

The layer that covers the nerves called the myelin sheath becomes destroyed and the person develops symptoms such as blurred vision, gait difficulties, slurred speech, numbness, fatigue and memory issues.

MS affects 2.3 million people worldwide and two to three times as many women are affected than men. Its exact cause is unknown.

Most patients are diagnosed with one of two main types of MS

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– Relapsing-remitting MS (RRMS) affects 85 percent of those with MS. These patients have attacks or relapses of increased symptoms followed by periods of partial or complete recovery.

– Primary-progressive MS (PPMS) affects 10 percent of MS patients. These patients have steadily progressive symptoms, without distinct relapses or remissions.

A relapse or flare-up of multiple sclerosis is considered to be the appearance of a new symptom or worsening of an old symptom that lasts over 24 hours, and is not considered to be directly related to another infection in the body.

Relapses can be caused by:

1) Infection

When the body is fighting off an infection, this can increase an additional immune response, which can trigger MS symptoms.

“Urinary tract infections are common causes because some people with MS have reduced bladder function,” according to Devon Conway, MD, a neurologist at the Cleveland Clinic, as reported on EverydayHealth.com.

Any infection can lead to an MS flare, so frequent hand-washing and staying clear of others who are sick is recommended.

2) Vaccinations

While it is recommended that MS patients have vaccinations to avoid developing infections, live virus vaccines such as the flu mist should be avoided.

Vaccines for yellow fever and for shingles are usually not recommended, reported ConsultantLive.com, but should be discussed with the patient’s doctor.

3) Postpartum period

Some studies have shown that MS symptoms can flare up during the postpartum period.

There has been evidence that breastfeeding exclusively during the first trimester after giving birth can decrease exacerbations during that time.

Medications for MS are not recommended to be taken while breastfeeding so consulting with your doctor is important.

4) Stress

Stress is commonly believed to be a trigger for MS symptoms but the exact relationship is not clear and may be different for different patients.

Building a strong support system is important in order to reduce stress as well as to make time for relaxation activities.

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5) Vitamin D

An association between low vitamin D levels and increased MS exacerbations has been found, according to ConsultantLive.com.

Serum level of 25-hydroxyvitamin D3 should be monitored in patients with MS and supplemented if it is low.

6) Heat

Increased body heat has been found to be a common trigger of MS flares. This includes having a fever from an infection.

MS symptoms such as tingling have been found to be worse in the summer. It is important for MS patients to be able to escape the heat by taking cool showers or spending time in air-conditioned areas.

7) Fatigue

Sleep is important for everyone but is it especially important for MS patients. Lack of sleep can add to already low energy levels and trigger an MS flare.

Conway stated that a relapse that causes serious symptoms usually needs to be treated. However, old symptoms that reappear that are not as serious, and often go away without needing treatment.

According to the MS society, most neurologists recommend a short course of high-dose steroids to reduce inflammation and to help shorten the relapse for severe exacerbations. For example, loss of vision, severe weakness or poor balance may be involved.

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