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Evaluating Possible Relapses

When determining whether a patient is experiencing a relapse or something else, medical teams have many tools at their disposal, including:

  • Clinical History
    • Have you had this symptom before?
    • Any clear triggers?
    • Duration of symptoms
    • Medication compliance
  • Obtain imaging
    • MRI scans with contrast (gadolinium)
    • Brain vs cervical spine vs thoracic spine
    • Looking for a new contrast enhancing lesion
  • Neurologic exam & rule out non-MS causes
  • Search for infection
    • Urinalysis/ Urine culture
    • Chest Xray
    • Stool test (if diarrhea)
    • Skin examination (for wounds, rashes)
  • Blood tests (indirect evidence of treatment effect)
    • White blood cells (looking for infection)
    • Anti-rituximab or anti-Tysabri antibodies
    • Immunoglobulin levels for those on Rituxan, Ocrevus or Kesimpta, which may cause depletion of these normal antibodies and increased risk of infection
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