Pseudo-Exacerbations in MS: Grounded in Reality

By Ann Pietrangelo, Care 2 make a difference

The word “pseudo” can be very misleading. The dictionary defines pseudo as “pretend; false or spurious; fake, artificial, sham; not actually, but having the appearance of.”

In the case of MS, you can disregard the words pretend, false, spurious, fake, artificial, and sham. A pseudo-exacerbation is not an imaginary event or a psychological disorder. It is not a cry for attention, and most assuredly is not fake.

It is not actually, but has the appearance of an exacerbation — along with all the very real physical symptoms. A pseudo-exacerbation is a flare-up of symptoms caused by another medical event or stressor, such as a urinary tract infection, fatigue, flu, or a simple case of elevated body temperature. Unlike a bonafide MS exacerbation, no neurological damage is taking place, which is great news in the long run, but doesn’t make its presence any easier to bear.

An MS exacerbation, or relapse, can cause new symptoms or progression of the disease, generally lasts anywhere from a few days to several months, and is caused by inflammation in the central nervous system. Damage to myelin disrupts the transmission of nerve impulses, causing the wide variety of symptoms associated with MS. Particularly severe relapses may cause permanent damage, prompting many doctors and their patients to choose steroid treatments in the hope of shortening the attack and avoiding long-term damage.

Pseudo-exacerbations generally are not treated with steroids, but may point to underlying health problems that need to be addressed. The cause of a pseudo-exacerbation may be something as innocuous as a little too much summer fun in the sun, but repeated attacks could be a sign that something else is wrong, and calls for further investigation.

Too many of us have a tendency to dismiss any and all physical symptoms as being MS-related. Ignoring glaring warning signs such as repeated pseudo-exacerbations could be a serious mistake. The problem is that it is often impossible, without diagnostic intervention, to know if a true relapse is taking place.

Whether it is a classic exacerbation or a pseudo-exacerbation, the symptoms are very real to the patient, and can have a devastating impact on daily life. Far too often, people with MS are accused of exaggeration or outright faking of symptoms.

Don’t let the word pseudo fool you. You are well-grounded in reality. It’s just part of the package that comes with multiple sclerosis.

Ann Pietrangelo is the author of “No More Secs! Living, Laughing & Loving Despite Multiple Sclerosis.” She is a member of the American Society of Journalists and Authors and a regular contributor to Care2 Healthy & Green Living and Care2 Causes. Follow on Twitter @AnnPietrangelo

Reposted from: Care2


About our Co-Founder: With a bachelors in Social Work, Linda is 53 years old, happily married with eight children and 17 grandchildren. Diagnosed with MS in 1995 and now having accepted and truly embraced her new reality, Linda has created She is dedicated to proving that joy can be chosen while living with Multiple Sclerosis. Linda specializes in helping others, especially those with MS attain the lifestyle, independence and happiness amid living with MS.


  1. My neurologist calls this condition “fatigability” meaning that when we’re stressed, for any reason – physical or emotional, many of our residual symptoms from previous attacks can flare up. Here’s an article that talks more about that:

    When I’m going through a period of off and on fatigability (mostly happens during the summer heat for me) I have to spend more time resting than usual.


    • Trish,
      I have never heard the term “fatigability’ ~ thanks for the information so we can read more! (I suffer from heat also!)

  2. Oooohh, I like that word – “fatigability”. My bad pseudo-season is not the summer but the cold, damp days of November and March (except for this year in NY – hoorah!!). If I’m having a flare-up of old symptoms, I usually give it a few days to calm down while taking a look at what’s going on in my life. Stress is a HUGE triggering factor for me. Like Trish, more rest is what I usually need.
    Thank you for pointing out that there is nothing “fake” about it!

    • Dawn,
      Isn’t it interesting, MS is continually different for everyone! I often joke by saying, “It’s all in my head.” That is not to say I’m making it up, it just is literally all in my head – well and spine!!

  3. In Connecticut, the MS Society is advocating for energy-assistance programs for people with MS, to financially help them with air conditioning, the same way low-income families can get help with heating costs in the winter.

    Even sitting in a hot tub for a while can cause symptoms to reappear, and they may last days (as opposed to weeks with “real” flares”).

    • Aili,
      Great! I’m so thankful for the MS Society! One of my first symptoms (I think I said this already :)) was turning into a noodle in a hot tub! My husband had to literally pull me out! It was wild, we were in a hot tub outside during the winter in Alaska. He had to carry me across the icy deck to get me into the pool area of the hotel. I’m still not sure why people enjoy sitting in a hot tub outside!

  4. I like this very informative post. I never thought of the possibility of “a flare-up of symptoms caused by another medical event or stressor”.

    • Louis,
      Like I said, I was ready to call my Dr. to get a prescription for IV Solumedral and now a few days later I’m doing better without it!

  5. Linda, Thanks for sharing your health concern with us, this can really help us in dealing our health lively… 🙂

  6. Hi Linda,

    Is there any link between diet and these pseudo-exacerbations? Maybe even indirectly. For example, a poor diet leading to a weakened immune system leading to the flu leading to the pseudo attack?

    • Derek,
      My opinion (and that is all it is, my opinion) our food consumption is directly connected to most (I want to say ALL but I hate those all or nothing words) of our physical conditions! I know that (I can’t remember if I updated the status of my pseudo attack here) but I tried to ‘sleep it off’ and it turned into a real exacerbation and I did the three days of Solumedrol to calm down my CNS. What ever, I’m back to my new normal, feeling great and enjoying every day of my new reality!

  7. This was helpful to me today…trying to decide what’s going on with new symptoms that started in April. So hard to know, maybe it was an exacerbation and now I’m having pseudo-exacerbations…heat, stress and less than optimal diet are all possibilities. The IV Solumedrol didn’t work, so now I get serious about managing the the rest and hope for relief!

    • Judy~
      I like to say ‘every day is an adventure’, saying that helps me feel stronger in this uncalled for condition. Heat does it to me! I don’t know how you do it! I read about cooling vests and drinking ice cold water. One day I sat with a cup of ice on my lap when we started this hot streak in AK. Just know that my thoughts and prayers are with you!

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