Nicoletta: Barbara asks, how unusual is it for a relapse to last longer than a year? Both relapses I’ve had have lasted over 12 months and I’m still not on treatment.
Dr David Rog, Neurologist: So that’s an interesting question. The answer is it’s unusual for the relapse itself to last that long before you then plateau, in other words, you get to your new normal after the disability that you accrue from the relapse or the symptoms. So I’d be interested to know, for example, whether Barbara’s two relapses were exactly the same in terms of the symptoms. I’d also be interested to know if she had any other lifestyle issues or issues in her general life that were relevant at the time. So, for example, if she was under a lot of physical or emotional stress or if she was sleeping properly, if she was looking after herself, whether she was overtly fatigued. And all of those things can contribute in terms of people not feeling back to their usual self, if you like. So I would be wanting to know if there were differences between those two attacks, and obviously I’m sure her neurologist would be assessing her very carefully, both in terms of what she says, the findings when we examine people, and also with MRI scans, for example.
Nicoletta: How long would you expect a relapse to last?
Dr David Rog: So, I can answer that in two ways. The first is that I would normally expect a relapse to last weeks to months, so short term symptoms that last a few days are less likely to be a relapse, particularly if the patient has experienced those symptoms before and if they’re predictable in some way. So I get an infection and when I bend my neck forwards I get an electric shock or a shooting pain, you know, down my spine, or I start dragging my leg. Or if I’m not sleeping properly I notice that I’ve got more tingling in a hand or I’ve got reduced sensation or dexterity and when I rest up it goes away again. So the short-lived symptoms are unlikely to be a relapse, because we have to remember that relapses usually correlate with new inflammation, so in other words, a new white dot or dots on an MRI scan, rather than changes in the speed at which messages get down the nerves, which is something that’s more susceptible to changes in environmental factors such as sleep, temperature, lactic acid and so on. So on the other side of the question, I would normally expect a relapse to develop over several days, perhaps up to a week or two, then I would expect there to be a plateauing in the symptoms, so the person notices that things aren’t getting any worse, and then there’s some degree of recovery.
And again, you know, you can accelerate the recovery, you don’t change the ultimate outcome but you can accelerate the recovery by using high dose corticosteroids, either intravenously or orally, but again, it depends on when you consult the medical professional or the nurse regarding your symptoms as to whether or not we think that’s appropriate. So after a few weeks to a few months I would have expected the recovery to have begun and substantial recovery to continue, and of course if it doesn’t and you start to get new symptoms on top of the other ones, and this does happen sometimes, people’s relapses run into each other almost, sometimes it can be difficult to tell one relapse apart from another. So in theory, you should be able to separate relapses out by a period of at least a month of stability, clinically, and/or on the MRI scans, unfortunately for some patients that doesn’t happen and just one thing seems to happen after another. That is relatively rare, but it is recognised and obviously it’s those patients that we particularly need to assess very carefully and then decide upon treatments.
Nicoletta: Thank you.
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Dr David Rog is a consultant neurologist at the Salford Royal NHS Trust. He gained his MD in liverpool and he completed his neurological training between 2002 and 2006 on the North West rotation at Lancashire Teaching Hospitals Trust and Greater Manchester Neuroscience Centre. Dr Rog is the Chairman of the Clinical Research Steering Group at Salford Royal and the Nervous System Theme lead for Greater Manchester Comprehensive Local Research Network.