MS Relapse MS is a demyelinating disease process. An MS relapse will have cooresponding enhancing lesions on MRI. A pseudo-relapse will not show any new lesions on MRI. If it is a pseudo-relapse, treat the underlying cause (e.g. infection). If it is an MS relapse, treat with steroids, and if severe, IVIG/PLEX. Other demylinating diseases to keep on your differential are NMO, MOG, CNS Sjogren's, and toxic, inflammatory and metabolic disorders. MS History Current outpatient neurologist: _______ Date of last out-patient visit: _______ Type of MS Relapse-Remitting
Primary Progressive
Secondary Progressive
Residual neurological deficitis: _______ Uses walking aide
Medication Management Prior Disease Modifying Therapies Injectibles Oral Medications Infusions Current Disease Modifying Therapies Injectibles Oral Medications Infusions Current Symptomatic Management Spasticity Bladder Bowel Depression Fatigue Pain Gait Other Management Most recent brain/spine imaging: _______ Current tobacco use (if yes, counsel on cessation)
Taking vitamin D? (if no, check vitamin D and supplement accordingly)
Plans for pregnancy
Currently pregnant (decreased risk of relapse)
Currently post-partum (increased risk of relapse)
Current Relapse Onset 1 day ago
2-3 days ago
4-5 days ago
6-7 days ago
Weeks ago
Months ago
Duration of symptoms (must be at least 24hr) 1 day
2-3 days
4-5 days
6-7 days
Weeks
Months
Relapse Symptoms Change in vision
Change in strength
Change in coordination
Change in sensation
Spasms
Change in bowel function
Change in bladder function
Change in sexual function
Change in gait/vestibular function
Change in energy level
Change in cognition or mood
Change in speech
Exercise or heat-induced (Uhthoff phenomenon)
Relapse Triggers Recent sick contacts or infectious symptoms
Recent vaccination
Recent pregnancy
Currently breast-feeding
If history of prior relapse Date of last known relapse: _______ Clear precipitant identified: _______
Patient went to the ED or was hospitalized
Patient received treatment (IV or PO steroids, IVIG, PLEX)
Patient experienced treatment-related adverse effects: _______
How long before symptoms improved Minutes
Hours
Days
Weeks
Patient required rehabilitation services (PT/PT/Speech)
If history of prior pesudo-relapse Date of last known pseudo-relapse: _______ Clear precipitant identified: _______
Patient went to the ED or was hospitalized
How long before symptoms improved Minutes
Hours
Days
Weeks
Patient required rehabilitation services (PT/OT/Speech)