I was just dx in February. I started having tingling in my face & slurring my words in December and it happens about 10 - 20 times each day. ..sometimes for a couple minutes but sometimes just seconds. What's the terminology? Is it all one relapse with flare-ups or is each little episode a "relapse"? I was diagnosed with RRMS right away because the MRI showed several lesions & I had a few days limping last spring that I unfortunately didn't follow up on
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Hi DarbySnow:
It's good that you're wondering about terminology, because an understanding of terminology is important to an understanding of MS. (And a misunderstanding of terminology is responsible for so many people being perpetually perplexed about MS.)
The 2010 MacDonald diagnostic criteria define a relapse/attack/exacerbation/flare as patient-reported or objectively observed events typical of an acute inflammatory demyelinating event of the central nervous system, current or historical, with duration of at least 24 hours, in the absence of fever or infection.
The general definition of a flare is the onset of new, or the worsening of existing, symptoms that lasts a minimum of 24 hours, in the absence of fever or infection, and is separated by the start of a previous flare by 30 days.
Those statements contain two important points. First, relapses are inflammatory events in which myelin is damaged. They last from days to weeks. The criterion of 24 hours is to ensure that the event is one of demyelination.
Second, increases in body temperature can cause damaged nerves to misfire or misprocess electrical signals, leading to an increase in symptoms that can be identical to an actual inflammatory event. Fever and infection cause an increase in body temperature. The criterion specifying the absence of fever or infection ensures that the event is truly an inflammatory event, not a heat-related misfire (called, not surprisingly, a pseudo-exacerbation).
It's important to know that nerves don't demyelinate -- causing a symptom -- and remyelinate -- ending the symptom -- in a matter of seconds or minutes or hours. Those seconds- to minutes- to hours-long increases in symptoms are not attacks/flares/relapses/exacerbations. And unlike what you may read on message boards and in chat rooms, there's no such thing as a "mini-flare." Those are not inflammatory, demyelinating events.
Those momentary events are called paroxysms.
Paroxysmal symptoms are not each a flare. However, multiple occurrences of a paroxysmal symptom can indicate the onset of a new flare if, as a group, they occur as the onset of new, or worsening of existing, symptoms lasting a minimum of 24 hours.
An important point is that paroxysmal symptoms can become quite common later in the course of MS after nerves have incurred long-term to permanent damage. Symptoms can worsen and ease over the course of a single day as a result of normal variations in body temperature, hydration, and hormone and chemical levels. None of them are flares.
Another important point is that symptoms can persist long after the inflammation of a relapse has resolved. Those symptoms are caused by nerve damage. This is where the definition of relapse becomes a little murky. Technically, when the inflammation that caused a relapse has resolved, the relapse has ended. But since the definition includes the presence of symptoms, the continuation of symptoms makes it hard to define when the flare has resolved.
That applies to the situation you described about your symptoms. The tingling in your face and slurring of words started in December; the inflammatory phase resolved within a few weeks -- end of December, sometime in January. The persistence of your symptoms doesn't mean that you're still in a relapse, even though it might seem that way. It might be helpful to discuss this terminology (and its impreceness) with your neurologist, who can apply the terminology to your individual situation. -
[QUOTE=jreagan70;1492187]Hi DarbySnow:
Those momentary events are called paroxysms.
Paroxysmal symptoms are not each a flare. However, multiple occurrences of a paroxysmal symptom can indicate the onset of a new flare if, as a group, they occur as the onset of new, or worsening of existing, symptoms lasting a minimum of 24 hoursTE]
I feel like they are getting less frequent....sometimes as few as 6 in a day. I have completely changed my diet and exercise habits since diagnosis and vitamin D & b12 too. I hope it will help. Thank you so much for taking the time to give me such an informative & detailed reply!Comment
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