A friend was asking me about flare-ups, exacerbations, attacks, etc. and I was having an awful time trying to define the terms. So, I looked them up in the official glossary on the official National MS Society website. Can't get any more official than that!

Here's what I found:

Exacerbation
The appearance of new symptoms or the aggravation of old ones, lasting at least twenty-four hours (synonymous with attack, relapse, flare-up, or worsening); usually associated with inflammation and demyelination in the brain or spinal cord.

Pseudo-exacerbation
A temporary aggravation of disease symptoms, resulting from an elevation in body temperature or other stressor (e.g., an infection, severe fatigue, constipation), that disappears once the stressor is removed. A pseudo-exacerbation involves symptom flare-up rather than new disease activity or progression


We kind of use those terms interchangeably, and now I see why! Lots of overlap, wiggle room, and grey areas. It even looks as though a pseudo is a flare-up of SYMPTOMS, where an exacerbation or "flare-up" is a flare-up of the DISEASE. Huh??

No wonder we have a hard time understanding this disease, much less explaining it to somebody else! Is "severe fatigue" the stressor, or the symptom? Or both? If it lasts 48 hours, does that mean it's a true exacerbation, or just that the "stressor" didn't go away for two days??

Add this to the fact that we each have our own interpretations of what all this means. When I was a newby, I remember a thread where there were about thirty posts of people saying "Well, this is what I think".

Where's that screaming smiley icon when I need it? I think I'm having a flare-up.