How Do I Know if My MS is Worsening?

Two or more significant attacks or relapses in a year or recurrent yearly attacks are concerning for inadequately controlled disease.

Examples of a significant attack or exacerbation are both legs becoming weak for 2 months or severe visual loss out of one eye for two weeks. A couple of attacks of mild temporary numbness may be less worrisome. For an acute attack, methylprednisolone (Solu-medrol) is generally given as 1 gm in the veins over 1 hour daily for 3-5 days. Many neurologists follow the course of steroids in the vein with oral steroids, but there is no evidence that the oral steroids are necessary and generally no oral steroid taper is given in clinical trials for attacks. Trouble sleeping, high blood sugar, and rare hip bone injury are some side effects and risks of the steroid infusion.

Another sign of worsening disease is developing more disability. For example, developing worsening balance over a year to the point of now needing a cane. Multiple, new active MRI lesions on the brain or spinal cord over one to two years may indicate inadequately controlled disease. Minimal MRI change without relapses or worsening disability might be monitored with follow-up MRI imaging.  However, new MRI changes on treatment for one year makes you at higher risk of disability compared to someone without MRI change.  The more new MRI activity, the higher risk for disability progression.  MRI change alone could prompt a decision between you and your neurologist to consider other treatment options.