What is the difference between new active lesions and an exaserbations?

[Tracy42]

I hope I spelled that right!

Thank you!

[22cyclist]

Not all exacerbations make new lesions. Most include active lesions, ones that show up on MRI as bright after contrast, but this can be old lesions that are just lit up. Sometimes exacerbations are caused by old lesions that do not light up with contrast. New lesions generally cause new symptoms that you haven't had before. You will know when there is a new one. So there it is as convoluted as can be.

Hope that clears some things up for you, and didn't make it worse.

Lisa
Moderation Team

[Tracy42]

Thank you

This sure is a confusing disease...

Thank you!

[imrachelk]

This sure is a confusing disease...

Thank you!

I just have to say YOU ARE NOT KIDDING ... I HAVE NEVER BEEN SOO CONFUSED IN MY LIFE.

[MSer102]

I think one of the things that makes it confusing is that the definition of a relapse/exacerbation/flare goes back a long time to before MRIs were used. The definition is based on symptoms. The definition is that a relapse is the onset of new symptoms of the worsening of existing symptoms that last more than 24 hours. Nothing about MRI evidence because it didn't exist at the time of the definition. I think it might be time for a new definition.

Your question was only about new active lesions vs. relapse. But a lesion doesn't have to be new. It can be an old one that became active again.

And another confusing thing is that a person can have definite new or worsening symptoms and an active lesion doesn't show up on MRI. But there has to be one somewhere to explain the symptoms. And there can be new lesions or reactived old lesions that don't cause noticable new symptoms. That counts as disease activity but it doesn't count as a relapse. Go figure.

Because its possible to have active lesions and no symptoms I completely disagree that a person always knows when there's a new lesion or a reactivated one. There's even a condition called radiologically isolated syndrome where a person has MS lesions on MRI that are found by accident when looking for something else and the person has had no symptoms and no idea at all they have MS. I think that's proof that a person doesn't always know about new lesions.

[Tracy42]

Thank you so much

Thank you for helping me to understand...