Is MS active all the time?
How do we know when multiple sclerosis (MS) is causing damage? What’s happening in your brain when you’re not having a relapse? Here we’ll take a look at the relationship between how you’re feeling and what’s going on in your brain – it might not be as straightforward as you first thought.
- About 85% of people living with MS experience relapses and remissions
- It’s when MS is causing damage to the central nervous system (CNS) that it’s referred to it as being ‘active’. This MS activity is often visualised on a magnetic resonance imaging (MRI) scan
- The consequences of MS activity are not always predictable as it can cause damage that builds up over time, only causing symptoms later on
- If your MS does not appear to be causing any damage on your MRI scan and if you’re not experiencing any symptoms, your doctor, or MS nurse may say that it is currently “not active” – however, you should always keep an eye out for compromises you’re making due to your MS
- Brain cell damage from MS can start before you experience symptoms
- The level of damaging inflammation caused by MS is highest in people living with early relapsing disease as indicated by MRI
- Brain shrinkage, or atrophy, can already be found in people who have had just one relapse
- Your MS symptoms have lasted for at least 24 hours
- You don’t have a fever or infection
- Your MS symptoms happened at least 30 days after a previous relapse began
- There’s not another reason for your MS symptoms, such as side effects caused by any treatments you are taking. Find out more about the difference between side effects and symptoms.
It’s great when you feel better. But feeling well doesn’t always mean your MS isn’t causing damage to your CNS, or that it’s not active. Some of the MS-related damage, or lesions, in your CNS are directly linked to the various symptoms you feel. But there may be lesions present that aren’t resulting in any noticeable symptoms, and these are known as silent lesions.
The occurrence of damage, or lesions, in your CNS is reflected in what is called an MS relapse. A relapse is the appearance of new symptoms or the return of old ones, which then fade away – either partially or completely. They can be as short as 24 hours but can potentially last a couple of weeks or more. If you have relapsing remitting MS (RRMS), an MS relapse will be followed by a period of recovery during which your symptoms will disappear or improve. This period of feeling better is called a remission. Even though your symptoms may have subsided, your MS can still be causing damage to your brain during periods of remission.
In other words, MS can be actively damaging your CNS without you knowing. Only an MRI scan can detect silent lesions in your CNS.
Here are some findings from scientific research:
That’s why it’s really important to talk to your doctor about your brain health, so that you can work together to make sure you’re managing your MS in the best way possible for you.
The brain is an amazing organ and sometimes it is able to repair the damage caused early on in MS, or it can even compensate for it by using alternative pathways in your brain. This explains why you may feel relatively well even while MS is causing damage to your CNS. It also accounts for why you may be able to fully recover from a relapse early on in your condition.
But once damage to your CNS becomes more extensive, the brain may no longer be able to compensate. That’s why you may only notice more permanent changes to your physical, emotional and mental functioning later on in your disease.
To be sure that your symptoms are an MS relapse, some of the things your doctor or MS nurse will check are that:
- Lublin FD et al. Neurology. 2014; 83(3): 278-286.
- MRI and MS: 7 things you need to know. Available at: https://www.mssociety.org.uk/ms-research/research-blog/2017/02/mri-and-ms-7-things-you-need-know. Last accessed: October 2017.
- Giovanni G et al. 2017. Brain health: time matters in multiple sclerosis. Available at: https://www.msbrainhealth.org/report. Last accessed: October 2017.
- Relapsing remitting MS. Available at: https://www.mstrust.org.uk/a-z/relapsing-remitting-ms-0. Last accessed: October 2017.
- Gold R et al. Ther Adv Neurol Disord 2010; 3: 351–67.
The Science of MS
Take a deeper dive into the science behind multiple sclerosis and learn how the way your brain works is affected when you’re living with MS.
How RRMS progresses
Learn about the types of MS and how relapsing remitting MS (RRMS) progresses over time
Monitoring the brain in MS
Learn about how MS activity is monitored, specifically how MRI scanners are used to see what is going on in your brain.