Pseudo MS-What Is It?

One morning I was getting ready for work and out of the blue my hand started getting tighter and tighter to the point it curled up into a ball.  I had to stop getting ready and sat on the couch hoping this would stop. After 15-20 minutes of massaging my hand and nothing changed and also noticed that my whole body felt like it was a frozen statue.  I couldn’t move my legs, I could only move the upper part of my body.  I started to panic thinking this was a symptom of MS. Thank goodness I thought to bring my phone with me. After all the symptoms didn’t improve and were getting worse I called 9-1-1.  They had an ambulance at my house in 6 minutes. The EMT asked me all kinds of questions, I told him my history of  having Multiple Sclerosis, took my blood pressure, oxygen saturation and the whole gamut. Still my symptoms hadn’t improved so they took me to the ER.  After taking an MRI and blood tests they told me that there are no new lesions and don’t see any signs that this is active MS. So they released me to go home.  What the what?….I thought.  How in the heck can my body seize up like that and this not be MS?

I remember being at home, resting on the couch and thinking to myself…..did the ER Dr. even contact my Neurologist so he’s in the know of what just happened? I thought to myself, “I bet they didn’t and just took it upon themselves to diagnose me.”  So I sent my Neurologist a message letting him know what happened and thinking he’ll probably want to see me.

I received almost an immediate response from my Neurologist and he stated that “the ER Dr had notified him and kept him abreast of the findings on the MRI and the blood tests.  The MRI had only shown one (1) new lesions and was not enhanced, therefore; they deem that acceptable to not show “active MS” and the blood tests had only shown that I was slightly low on vitamin D, which would not correlate with an MS attack.  I was absolutely shocked to hear this from him.  I then asked him, if this is not an “active MS” attack, then how can my body seize up like this?  He then began to explain to me that this is Pseudo MS attack.

What is Pseudo MS?

You are not alone if you have ever felt your MS symptoms suddenly arise or increase in intensity. Perhaps you felt your legs go numb or an overwhelming cloud of fatigue wrap around you.

While distinguishing an MS exacerbation from a pseudo-exacerbation can be tricky, it’s an important first step. This is because a pseudo-exacerbation does not require treatment with steroids like Solu-Medrol and it does not affect a person’s long-term disease course.

Distinguishing a Pseudo-Attack


Multiple sclerosis (MS) exacerbation (also known as a relapse attack, bout, or flare) occurs when a person experiences either new MS symptoms or a worsening of old symptoms. For example, a person may experience new muscle weakness in their legs or worsening balance problems.

While it’s normal to be worried, even panicked, that you are experiencing an MS relapse or exacerbation, this is not necessarily the case. You may be experiencing a pseudo-exacerbation, which is a “false” MS exacerbation or relapse.

While distinguishing an MS exacerbation from a pseudo-exacerbation can be tricky, it’s an important first step. This is because a pseudo-exacerbation does not require treatment with steroids like Solu-Medrol and it does not affect a person’s long-term disease course.

Distinguishing a Pseudo-Attack

Multiple sclerosis (MS) exacerbation (also known as a relapse attack, bout, or flare) occurs when a person experiences either new MS symptoms or a worsening of old symptoms. For example, a person may experience new muscle weakness in their legs or worsening balance problems.

Four Features of Pseudo-Exacerbation

  • No new MS damage is occurring
  • Triggered by an outside factor
  • Symptoms are reversible
  • Lasts less than 24 hours

On the contrary, with an MS pseudo-exacerbation, a person experiences a temporary increase in their symptoms. This temporary increase in symptoms (such as fatigue or tingling in their arms and legs) is brought on by some sort of outside trigger such as heat or stress. The temporary increase in symptoms with a pseudo-exacerbation implies there is no MS-related inflammation going on in the brain or spinal cord—although, it can certainly feel like it.

Pseudo-Exacerbation Triggers

There are multiple potential factors that may trigger an MS pseudo-exacerbation. By learning about these triggers, you can hopefully prevent pseudo-exacerbations in the future (as best as you can).

An infection, most commonly a urinary tract infection (UTI), is a frequent trigger of a pseudo-exacerbation.

Since many people with MS suffer from bladder problems, like decreased bladder sensation, they may not have the classic, obvious symptoms of a UTI (such as burning with urination or urinary urgency).

Increase in Core Body Temperature

Anything that increases your body temperature—taking a hot shower or bath, having a fever, engaging in strenuous exercise, or being outside in the heat—may result in a pseudo-exacerbation.

In fact, an increase of only .5 degrees Fahrenheit in core temperature is needed to trigger an increase in MS symptoms.

The good news is that once a person cools down, their MS symptoms resolve.

Due to the fact that this “heat trigger” is so common in people with MS (it even has its own name, called the Uhthoff phenomenon), MS doctors frequently remind their patients to undertake cooling preventive strategies, such as:

  • drinking cold water throughout the day, especially during hot summer months
  • wearing a brimmed hat, sunglasses, and light, breathable clothing in sunny weather
  • dipping your feet and hands in cool water if feeling overheated
  • wearing a cooling neck collar or vest or using a pocket fan when exercising or out in the sun
Lastly, if you have a fever, talk with your doctor about taking a fever-reducing medication, such as Tylenol (acetaminophen). Of course, it’s also important to treat the underlying illness.

Stress

While difficult to quantify, stress can trigger an increase in MS symptoms. Since stress may be related to depression and/or anxiety, your doctor may suggest a combination of talk therapy with an anti-depressant or anti-anxiety medication.

Other stress-easing strategies include engaging in mind-body therapies like mindfulness meditation, relaxation training, and yoga. Keeping a journal, not over-scheduling, and daily exercise can also do wonders for your stress levels.

Fatigue

Fatigue is a very common symptom in MS, stemming from the disease itself, as well as other factors related to having MS. For instance, certain medications meant to ease MS symptoms, like vertigo, bladder problems, or spasticity may worsen your fatigue, which can then trigger a pseudo-exacerbation.
Likewise, fatigue in MS may stem from poor sleep habits, especially if you are getting up multiple times during the night to use the bathroom or to ease your leg cramps.

Combating MS fatigue often entails a multifaceted approach including aerobic exercise, adequate sleep, energy conservation, and sometimes, taking a stimulant medication, like Provigil (modafinil) or Symmetrel (amantadine). Mindfulness-based cognitive behavior therapy (MBCT) may also be helpful.

Hormone Changes

Hormone changes, such as those that occur during menstruation and menopause, may trigger a pseudo-exacerbation. If you find that your MS symptoms consistently flare during your monthly period, or are occurring as you approach menopause, it’s sensible to speak with your doctor about various treatment options.

In the end, I learned that the extreme stress (personally and professionally) I was going through at the time, is what had caused this “pseudo MS attack” and I was actually relieved to know my MS was not truly active and the symptoms I was experiencing would subside.  And they did by the following morning (within 24 hours).

MS is a complex neurological disease, and determining whether or not you may be suffering from a “pseudo” versus a “real” MS flare only adds to its mystery and unpredictable ways. Be sure to call your doctor if you are not feeling well, sense something is off, and/or if you are experiencing new or worsening MS symptoms for more than a day. In some cases, what you may be thinking is a pseudo-exacerbation could be a real exacerbation—and while this is disheartening to learn, the faster you address it, the better.

Leave a Reply

Your email address will not be published. Required fields are marked *

Download Your ComplimentaryWellness 360 Adding-In Challenge Blueprint

Take the Wellness 360 Challenge and discover a proven method to create a healthy lifestyle with ease!

YOU Wellness NewsletterDon't miss out on these healing therapies....

Subscribe to YOU Wellness Newsletter for natural healing remedies for those living with MS, Auto-immune disorders and other health challenges.