Get ahead of MS attacks

Multiple sclerosis (MS) is a disease that affects the central nervous system (brain and spinal cord). MS can cause a variety of symptoms, including numbness and tingling in the arms and legs, eye irritation, fatigue, and balance problems.

People with MS often experience fluctuating symptoms and some days have few symptoms. In the relapsing-remitting form of the disease, most people experience days (or even weeks or months) of good days, followed by sudden onset of new symptoms and/or worsening of existing MS symptoms. This is called an MS attack, and is sometimes called a flare, relapse, or exacerbation.

MS attacks are triggered by inflammation of the central nervous system. Inflammation damages myelin (the protective layer around nerve fibers) and disrupts the transmission of nerve signals. Blocked signals fail to reach their targets or allow the brain to interpret certain signals, causing MS symptoms.

This article provides information about MS attacks and how to deal with them.

MS attack symptoms

Although about 85 percent of people with MS experience an attack, no two people experience an attack in exactly the same way. Symptoms vary with each attack. Sometimes you may have mild attacks, and other times the symptoms may be so severe that they affect your quality of life. You may experience only one or more symptoms, depending on which areas of the central nervous system.

Symptoms of an MS attack include:

  • balance problem
  • Bladder problems (such as loss of bladder control or frequent need to urinate)
  • Dizziness
  • fatigue
  • memory problem
  • liquidity problem
  • Numbness or tingling in the legs and/or arms
  • inability to concentrate
  • vision problems

The ebb and flow of symptoms

Symptoms during an MS attack may gradually worsen over time, then gradually decrease and level off. Over time, symptoms will subside and you will begin to recover. In some cases, symptoms disappear completely. In other cases, they may not disappear completely, but will be less intense than during a flare.

Identify emergencies

To determine that the onset of symptoms is an MS attack, there are a few things to consider, including:

  • New symptoms appear and/or previous symptoms get worse: Many people with MS have persistent symptoms, but they tend to remain stable between episodes. When symptoms change, this may indicate a flare-up.
  • Symptoms last 24 hours or more: Attacks usually last more than a day.
  • Symptoms appear at least 30 days after your last attack: Your MS symptoms must be stable for at least a month before symptoms worsen or new symptoms appear.
  • Symptoms have no other explanation: Illness, stress, and other factors can be mistaken for seizures. After these factors are ruled out, an MS attack is likely.

If you’re not sure if you’re experiencing an MS flare-up, wait a day or two before speaking with your doctor to see if your symptoms improve. Depending on the severity of your symptoms, your doctor may want to see you in person to make sure you don’t have an infection and may adjust your treatment plan.

What is a false exacerbation of MS?

how long can they last

To be eligible for an MS flare, symptoms must last at least 24 hours. The duration of the attack varies depending on the severity of the inflammation on the central nervous system. MS attacks can last anywhere from a few days to weeks or months.

MS attacks tend to occur most often in the first few years after diagnosis. However, they can occur at any time throughout the disease course.

MS Attack Trigger

The researchers continue to explore what triggers the MS attack. These factors appear to be associated with an increased risk of attack:

  • Age: Adults 50 years and older have a higher risk of relapse than younger adults. This may be because inflammation in the body tends to increase with age, leading to an increased risk of age-related diseases and MS flares.
  • Hormones: Studies show that men with MS are more likely than women to relapse. This may be due to reproductive hormones, which may play a role in the likelihood of flare-ups and the type of symptoms experienced during flare-ups. Men tend to have more severe recurrent symptoms related to cognitive function and balance, while women tend to have more visual and sensory symptoms.
  • Infections: Viral or bacterial infections, such as urinary tract infections (UTIs), pneumonia, and bacterial skin infections, can trigger an MS flare-up. The researchers estimate that about 27 percent of MS flares are triggered by infections in the weeks before MS symptoms.
  • Stress: Experiencing a stressful event or chronic stress can trigger aggression. An analysis of 14 studies showed a link between nontraumatic stress-level events and MS relapse.
  • Vitamin D levels: Studies have shown that people with MS who have insufficient levels of vitamin D in their bodies have a higher risk of developing attacks. In one study, increasing vitamin D levels reduced the risk of seizures by 42%.

Vitamin D Supplements in Multiple Sclerosis

What to Help During an MS Relapse

self care

MS aggression can be physically and emotionally challenging. Self-care is always important, but it’s especially important when you’re under or recovering from an attack. You may need to make some adjustments to your routine to give yourself a chance to fully recover, including doing the following:

  • Get plenty of rest: Physical activity can be challenging during an MS flare-up. You may also have a harder time performing everyday tasks. Give yourself plenty of rest and eat a healthy, nutrient-dense diet during recovery.
  • Seeking support: It’s not always easy to seek help, but connecting with friends, family, and others in your community can help you get the emotional and physical support you need to get through an attack.
  • Consider treatment: Living with MS is not easy, and many people with the disorder experience periods of depression and anxiety. Talking to a mental health professional can help you address your emotional needs and deal with whatever you’re going through.
  • Be gentle with yourself: You may feel depressed because of new or worsening symptoms. Be gentle with yourself and know that you are doing the best you can in a frustrating situation. Talk to yourself like you would a dear friend and be patient as you get through this difficult time.

7 Multiple Sclerosis (MS) Support Groups


Not all MS attacks require treatment. If new symptoms develop or existing symptoms worsen but do not affect your quality of life, you may notice that they go away on their own in time. Some attacks can cause more serious symptoms that require treatment, such as vision loss, severe weakness, or limited mobility, which your doctor may recommend.

Treatment for MS attacks includes:

  • Corticosteroids: The most common treatment for MS flares is short-term high-dose corticosteroids to reduce inflammation. These medicines can be taken by mouth (pills) or intravenously (IV).
  • HP Acthar Gel: a highly purified adrenocorticotropic hormone (ACTH). As an extended-release injection, this option is often used for people who cannot tolerate steroids.
  • plasma exchange: Plasma exchange is a treatment option for severe attacks not relieved by standard steroid therapy. This is done in a hospital setting, where antibodies are removed from your blood and replaced with filtered plasma (the yellow liquid part of your blood).

In addition to medication, your doctor may recommend rehabilitation to help you regain your strength and mobility, and to address any issues you may have with personal care and performance at work and home. You may see a physical therapist, occupational therapist, speech therapist and/or cognitive correction specialist.

Physical Therapy for Multiple Sclerosis: Restoring Mobility

when to go to the hospital

Talk to your healthcare provider if you develop new symptoms. They may want to see you in person to address your symptoms and revise your treatment plan.

If you have severe symptoms, you may need to go to the hospital. Go to the hospital during an MS attack if you:

  • Sudden inability to walk, eat, or use your extremities
  • loss of vision in one or both eyes
  • are experiencing severe pain
  • high fever (may indicate infection)


MS attacks, often called MS relapses, flares, or exacerbations, are common in the first few years after MS diagnosis. Symptoms of MS attacks vary widely and include balance problems, vision problems, numbness and tingling, and difficulty concentrating. If symptoms are severe, medications such as corticosteroids may be prescribed to reduce inflammation and control symptoms.

VigorTip words

Going through an MS attack can be a challenging time. Knowing your triggers, such as stress and low vitamin D levels, can help you practice good self-care to reduce the likelihood of new attacks. You may question whether you are really having a flare-up, or if there is something else that is causing this new onset of symptoms. If in doubt, please contact your healthcare provider.

While there is no cure for MS, many people with this disorder are able to lead comfortable and fulfilling lives with support and proper treatment.

Frequently Asked Questions

  • What does an MS attack feel like?

    Symptoms of MS attacks vary and include balance and coordination problems, vision problems, difficulty concentrating, fatigue, weakness, or numbness and tingling in the extremities.

  • Is ‘MS hugging’ a sign of relapse?

    An MS hug is a feeling of tightness or pressure around the abdomen and chest. It may be felt all over the chest or only on one side. You may notice that something like fatigue, stress, or temperature changes can trigger MS hugs. While it’s not always a sign of a relapse, it can be a symptom that occurs during an attack.

    understand more:

    Multiple Sclerosis “Embrace”

  • Do MS attacks occur in all types of MS?

    MS attacks occur in relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). Primary progressive multiple sclerosis (PPMS) is characterized by symptoms that worsen at onset of the disease without relapse or remission.

    understand more:

    Types of Multiple Sclerosis