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What is a relapse?
A relapse, or an ‘attack’ of NMOSD, occurs when there is inflammation within the nervous system. In NMOSD, this inflammation is usually within the optic nerve and the spinal cord. The inflammation causes people to experience new symptoms, or recurrence of symptoms that they have had previously.
Why do relapses happen?
We don’t understand what causes or triggers a relapse. Relapses are usually unpredictable and there is nothing that you may have done to cause them. Occasionally, a relapse may be triggered by infection or by stress.
What symptoms do relapses cause?
In people with NMOSD, relapses usually affect either the optic nerve or the spinal cord.
When relapses affect the optic nerves they cause problems with the vision. Symptoms normally come on over a period of hours or days, or people may wake up one morning with visual symptoms. Symptoms include:
- Pain behind the eye or on movement
- Colours appear faded or ‘washed out’
- Vision may be blurred or lost completely
Brief ‘stabbing’ pain in and around the eye lasting only a few seconds or minutes is unlikely to be caused by a relapse. Many people with NMOSD find that their vision varies from day to day, for example if they are tired.
People with NMOSD may also experience relapses affecting the spinal cord. The spinal cord controls strength and sensation in the arms, legs and trunk and is also involved in bladder and bowel control. Inflammation in the spinal cord may cause many different symptoms including:
- Weakness in the arms and/or legs,
- Numbness or abnormal sensations in arms/legs/trunk
- A band like sensation around the trunk, like being squeezed
- Severe pain in the neck or between the shoulder blades
- Problems with the bladder such as difficulty or inability to pass urine
- Constipation or loss of control of bowel movement
Each of these symptoms may occur individually, or people may experience a combination of symptoms. Usually symptoms develop over hours or days. They are significant if they last for longer than 48 hours.
What should I do if I think I’m having a relapse?
It is important to remember that most relapses of NMOSD need to be assessed and treated promptly. Please follow the guidelines below.
If you feel that there is a sustained deterioration in your vision or experience any of the symptoms described above which lasts for longer than 48 hours, please contact your NMOSD Nurse Specialist.
NMO Nurse Specialist NMO Nurse Specialist
Walton Centre for Neurology John Radcliffe Hospital
0151 529 8357 01865 231905
Your NMOSD nurse will take a history of your current symptoms, take into consideration current treatments, other illness (such as colds, infections) and how the symptoms are currently affecting you.
- Following discussion with the medical team, a plan will be devised on how best to assess and treat your relapse. This may involve asking your local neurologist to see you, or if possible ask you to come to your nearest NMOSD centre.
- Every patient and every relapse will have different features and the treatment will depend upon your individual needs.
- It is important that you are assessed quickly during a relapse, as early treatment may prevent long term damage.
Once infection has been ruled out relapses are usually treated with Methylprednisolone either 500mg orally for 7 days or 1gm intravenously for 5 days. Research has shown that both options are equally effective in treating relapses. Sometimes, particularly in the case of vision changes, we might treat with plasma exchange which is given intravenously once daily for five days.
Recovery from Relapses
The time taken to recover and the amount of function recovered after a relapse can be affected by many factors and varies hugely from person to person. An important factor to always consider is that any new symptom or sustained worsening of an existing symptom (over 24hrs) should be reported to either a general practitioner or NMO team for further assessment. Early assessment and treatment may prevent long term damage.
Please contact either NMO Centre for further Information and Advice
John Radcliffe Hospital, Oxford 01865 231 905
Walton Centre Foundation Trust 0151 529 8357
If you have problems out of hours, contact on-call neurologist at either hospital for advice.