Galea I, Ward-Abel N, Heesen C.

Relapse of multiple sclerosis is a patient reported, or objectively observed, event typical of an acute inflammatory demyelinating event in the central nervous system, current or historical, with a duration of at least 24 hours. The differential diagnosis of a relapse includes alternative neurological diagnoses, pseudo-relapses, short lived paroxysmal symptoms, day to day fluctuations, and functional symptoms. Clinically significant or severe relapses may benefit from treatment with corticosteroid for five days. Documentation and timely communication of the relapse to the patient’s multiple sclerosis specialist service, such as through the multiple sclerosis specialist nurse, is important, to enable timely decisions on immunotherapy initiation or escalation. Non-adherence with immunotherapy is under-recognised by both patients and doctors.

BMJ 2015;350:h1765.

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