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    Flare up vs. Attack

    Hello everyone. I've been a member for quite awhile, but don't post very often.

    My question is: how can I tell the difference between a "flare up" and an attack?

    Most of my symptoms seem to effect my left side. But this morning I woke up, and my entire right arm is weak, and has numbness & tingling. My entire left leg feels that was constantly (has for years), but never my right arm. And I'm scared that my previously "normal" arm now feels pretty much like my "bad" leg.

    I've had a very busy, stressful past few weeks, and over-did it, so I know this could just be a flare-up, my body's way of making me slow down and rest.

    But, because my symptoms are in an area that typically doesn't have symptoms, I'm concerned this could be an attack. And what concerns me the most is ... I don't know how to tell the difference.

    How do I tell the difference between the two? When do I step over the "just stay home and rest" line and seek medical attention and see if I need steroids?

    I hope this all makes sense, and I hope I posted it in the right section. Thank you for reading, and any words of wisdom you might have to share.

    I feel silly for asking this question ... but I've so far been very lucky and haven't had to go to the hospital.

    #2
    Hi april may june,

    A flare or exacerbation is the same as an attack or relapse- they are all words that are interchangeable and mean the same thing. Here is an article from the NMSS that explains relapses, exacerbations, etc. http://www.nationalmssociety.org/Tre...aging-Relapses

    I think it will be helpful for you - especially the part about treating an attack or flare up in reference to your pins and needles.
    The good news is that not all exacerbations require treatment. Mild sensory changes (numbness, pins-and-needle sensations) or bursts of fatigue that don’t significantly impact a person’s activities can generally be left to get better on their own.
    I generally just rest up and maybe this is just what you need? Hard to tell, but if things get worse, you might want to let your neuro know.

    I am sorry that you have had a stressful period of time. Hopefully, you can remove those stressors in your life and find some much needed relaxation!

    And p.s. - never feel silly for asking questions here! No question is silly. MS is so confusing at times and we all learn from one another. Take care!
    1st sx '89 Dx '99 w/RRMS - SP since 2010
    Administrator Message Boards/Moderator

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      #3
      Originally posted by april may june View Post
      My question is: how can I tell the difference between a "flare up" and an attack?
      There is no difference between them. Flare, flare-up, relapse, exacerbation and attack are all terms for exactly the same thing: an inflammatory episode that damages myelin (and possibly the underlying nerve cell) and causes an increase in symptoms.

      It sounds like your question is more of how to tell the difference between having an actual flare/flare-up/relapse/exacerbation/attack and just having the normal daily ups and downs of symptoms -- and possibly how to tell the difference between a real, inflammatory exacerbation and a pseudoexacerbation.

      Some people incorrectly use the term flare or flare-up to mean that they're just feeling more symptomatic than usual -- as in "I'm having a real MS-ey day." That may be how you picked up the use of the term. Medically speaking, though, that's incorrect, and it causes a lot of confusion. A flare-up does not mean that you're noticing more symptoms and your body is telling you to slow down. Likewise, some folks use the term "mini-relapse." There is no such thing as a mini-relapse.

      The general definition of a flare/flare-up/relapse/exacerbation/attack is the onset of new symptoms or the worsening of existing symptoms, in the absence of illness, that lasts at least 24 hours. That classification -- defined by symptoms -- is a bit imprecise, but it refers to an actual inflammatory event that does damage.

      Sometimes it's hard for a person to tell the difference, and sometimes it's really, really obvious. But when in doubt, the best course of action is to call your neurologist and let him/her figure it out.

      Symptoms can come and go during the course of a day in response to the normal ups and downs of body temperature and body chemicals. An increase in symptoms can be brought on by any prolonged rise in body temperature, including exertion and illness. These events can feel like a real relapse, but they are not inflammatory. Because they're not inflammatory or true exacerbations/relapses/attacks, they're called false exacerbations or pseudoexacerbations.

      The hallmark of pseudoexacerbations is that the symptoms subside when body temperature goes back to normal. They generally last from minutes to a few hours. The can last longer in the case of illness, which is why that definition of true relapse specifies that the symptoms should last 24 hour in the absence of illness. These are often the events that are mistakenly referred to as mini-relapses. But again, there's no such thing because these aren't relapses at all.

      So, back to your question. How do you tell the difference between a true inflammatory attack/flare/exacerbation and just an increase in symptoms from overdoing?

      Since you're having symptoms in an arm that usually doesn't have symptoms, it could be the onset of new symptoms, which is part of the symptom-based definition of a relapse. Has the new symptom lasted for at least 24 hours? If yes, you may be having a true flare/relapse/attack. That "when to step over the line" and seek medical attention point is the 24-hour mark. Some neurologists wait until 48 hours, just to be sure. So when in doubt, call your neurologist.

      As for steroids, steroids only shorten the length of the relapse; they don't have any effect on the final outcome. Mild relapses don't even need to be treated. But if a flare appears to be serious enough to interfere with daily activities, steroids should be considered. In shortening the length of a relapse, steroids work best when started within 2 weeks of the onset of the flare.

      Those are two good reasons to call your neurologist within a couple of days of a suspected attack/flare/etc. You don't have to figure it out on your own.

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        #4
        Thank you both so much for your answers!

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          #5
          JReagan....

          Thank you so much for the quote "I feel MS-y today"....that's exactly it!!! Some days I feel my symptoms more than others. They aren't new or different, they are just more pronounced. I have been trying to figure out what was going on (only diagnosed about 2 months ago) and that really put some context to it for me. Thank you!!!
          Diagnosed RRMS 4/7/15, symptoms for 8 months prior. Copaxone 4/27/15

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