Treating exacerbations with only physiotherapy

[whiteflagship]

I'm relatively new to the forum although I've made a few posts. I was diagnosed in 2004 and am having my first major flare since then.

I'm on my 4th day of a 5-day IVSM, 1g/day and then I will taper down.

My question is this - is it possible to treat a severe exacerbation with only physiotherapy and no meds, no IV, no oral meds etc? And by severe exacerb. I mean left leg going completely numb, unco-ordinated, unbalanced, weak (basically cant walk or stand on it), which has rendered my foot totally useless (for now).
Possible?

[Redwings]

Hi whiteflagship:
There are two aspects to treatment of an exacerbation: treating the cause and treating the effects.

I'm going to comment on treating the cause. Exacerbations are caused by inflammation, which leads to demyelination and nerve damage. Inflammation has to be treated chemically to suppress it, and demyelination has to heal on its own, however long it takes and to whatever extent it achieves. So it is not possible to treat the severe inflammation of an exacerbation without medications. In that respect, physiotherapy is not effective in treating the underlying cause of a flare because it doesn't treat central nervous system inflammation. Physiotherapy will also not treat numbness (an effect), which is purely sensory.

Physiotherapy can, though, help treat the effects of a flare that have a motor component. I'll defer to Susan Dorne to address the physical aspects.

[SusanD]

The best person to answer this is your physician. However, from what I understand about exacerbations, especially severe as you described, they are typically treated medicinally and then physical/physiotherapy afterwards.
There are different types, of medications (a form of steroid is most commonly given) to help with inflammation.

However, there are a few doctors who wait to assess the situation (time varies) to compare it with most recent and past situations. The physician may also have a concern with giving medication right away, perhaps there was a bad reaction before, issues with lab (blood work), or other concerns that explains why medicine wasn't given initially.

Keep the lines of communication open with the doctor. Don't be afraid to ask questions.
I'm curious, is your doctor a neurologist who specializes in MS?

[Redwings]

However, there are a few doctors who wait to assess the situation (time varies) to compare it with most recent and past situations. The physician may also have a concern with giving medication right away, perhaps there was a bad reaction before, issues with lab (blood work), or other concerns that explains why medicine wasn't given initially.

Hi whiteflagship:
Smart doctors do sometimes wait a bit to assess the situation. Some flares never get bad enough to warrant treatment. However, doctors who are knowledgeable about steroids and how they work in MS know that the sooner the steroids are started, the better. There is about a two-week window during which steroids are most effective. Beyond that, the damage has already been done and the chances that steroids will still be helpful to shorten the duration of the exacerbation become less and less. A knowledgeable and competent physician already knows near the beginning of an exacerbation whether steroids are indicated or contraindicated in a patient. Finding that out shouldn't take more than two weeks -- it shouldn't take more than two days.

Because of the reduced chance of getting a benefit from the steroids that exceeds the risk, many doctors won't even prescribe steroids after that two-week window has passed. An exception to that would be if a flare starts slowly and doesn't become serious enough for steroids until after two weeks have passed. It is not an exception to wait past two weeks and then start steroids because the flare didn't get better on its own before that. That's a waste of the valuable two weeks.

There are some borderline instances where the choice is made to not start steroids during the first two weeks. In cases of lingering inflammation, some patients do get benefit from using them later. But success isn't a given, and late use doesn't come close to the benefit that might be obtained if the steroids are begun soon after the beginning of the flare.

Mild flares don't warrant treatment. Even widespread flares don't have to be treated, because the ultimate outcome is the same whether the flare is treated or not treated. Except for the most serious flares, the primary goal is to shorten the duration of the flare, not to influence the outcome. You've already had your IVSM, so timing (probably) isn't an issue for you.

Remember that it's only chemical intervention that can shorten the duration of a flare. Physiotherapy alone cannot suppress inflammation or shorten the inflammatory phase of a flare. What physiotherapy can do is help to speed up the recovery of lost function by rerouting nerve signals to undamaged areas of the brain, stimulating nerves during their healing phase to reintegrate sensory and motor function, and restoring muscle strength and range of motion lost to atrophy.

[BigA]

Hi whiteflagship:
I'm going to comment on treating the cause. Exacerbations are caused by inflammation, which leads to demyelination and nerve damage. Inflammation has to be treated chemically to suppress it, and demyelination has to heal on its own...

Redwings, would you elaborate? I thought that demyelination caused inflammation. I though that anti-bodies slipped through the blood brain barier and attacked nerves, setting off inflammation. That way, a person could wake up one day unable to walk, but after a course of steroids, might gain full use back after the inflammation died down and healing/rewiring took place. Or is it more complicated. Inflammation -> Deemyelination -> Inflammation?

Thanks,