Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Abstract

Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies.

Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation

“…Generally, observational data have found male sex, older age at onset, progressive state at onset and higher number of MRI lesions to be predictive of a poor prognosis with faster disability progression. 74,75 A recent systematic review has identified several key factors related to relapse frequency and recovery. 75 Relapse activity appears to decrease with age and disease duration and cohort studies suggest that women experience relapses more frequently.…”

“…74,75 A recent systematic review has identified several key factors related to relapse frequency and recovery. 75 Relapse activity appears to decrease with age and disease duration and cohort studies suggest that women experience relapses more frequently. Modifiable risk factors, including smoking, exposure to infectious disease and discontinuation of DMTs, are also associated with increased relapse frequency.…”

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

“…Quality of life is reduced in patients with frequent relapses. The psychosocial burden due to relapse has a negative effect on social life and the family life of patients (6).…”

“…Higher number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem and spinal cord involvement are poor prognosis indicators. Conversely, sensory relapses, fewer relapses, and relapses with optic neuritis and recovery without sequelae are good prognostic features (6,7).…”

Ozone, NO2 and PM10 are associated with the occurrence of multiple sclerosis relapses. Evidence from seasonal multi-pollutant analyses

“…In addition, women appear to be at greater risk than males (Ascherio et al, 2014; Belbasis et al, 2015; Lauer, 2010). Relapses predisposing risk factors have been investigated to a lesser extent and associations reported are discordant, namely young age, short MS duration, low serum vitamin D levels, smoking, psychological and other stress, vaccination, infections, post-partum, breast feeding and assisted reproduction (McKay et al, 2016; Kalincik, 2015). …”