MS Relapse

MS is a demyelinating disease process. An MS relapse will have corresponding enhancing lesions on MRI. A pseudo-relapse will not show any new lesions on MRI. If it is a pseudo-relapse, treat the underlying cause (e.g. infection). If it is an MS relapse, treat with steroids, and if severe, IVIG/PLEX. Other demylinating diseases to keep on your differential are NMO, MOG, CNS Sjogren's, and toxic, inflammatory and metabolic disorders.

Last updated 3/27/2026

Current Relapse

Onset

Duration of symptoms (must be at least 24hr)

Screen for triggers associated with MS pseudo-relapse

Heat/elevated body temperature/dehydration (fever, hot weather, hot baths, exercise)

Infection (recent sick contacts, urinary tract infection, upper respiratory infection, etc)

Dehydration

Menstruation

History of prior relapse?

Date of prior relapse

HIPAA: Only the year will appear in summaries

Trigger identified

Treatment received (corticosteroids, IVIG, plasma exchange, other)

Time to symptom resolution or improvement

MS History

Date of MS diagnosis

HIPAA: Only the year will appear in summaries

Current outpatient neurology provider(s)

Date of last out-patient visit

HIPAA: Only the year will appear in summaries

Type of MS

Residual neurologic deficits

Expanded disability status scale score ( https://www.mdcalc.com/calc/2146/expanded-disability-status-scale-edss-functional-systems-score-fss )

Medication Management

Current disease modifying therapies

Prior disease modifying therapies

Other Management

Currently undergoing therapies (Physical therapy, Occupational therapy, Speech therapy, Cognitive therapy, Behavioral therapy)

Current tobacco use (if yes, counsel on cessation)

Plans for pregnancy