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Almost certainly, in MS the greatest fear is one of relapse. An exacerbation of MS symptoms most commonly occurs due to urinary tract/virus/other common relatively trivial illnesses. It has no connection with relapses and disease progression, but is usually mistaken as such.

A true relapse may be differentiated by the occurrence of new symptoms directly due to new lesions in the brain or spinal cord.

An exacerbation may be considered as a transient reactivation of inflammation in old lesions, which does not indicate a progression of new disease.

Either event may be induced by the occurrence of a stressful trigger situation, which may be either physical or emotional. Examples of physical triggers may include, most commonly, accident, injury or infection, when emotional stress is also invariably involved to one degree or another.

Purely emotional triggers might include such as grief, due to the loss of a partner or close relative; divorce, or moving house.

These various situations of stress cause changes in the natural physiology of the body resulting in what is referred to as oxidative stress. Oxidative stress is a situation where there is either an excess of free radicals, or a deficiency of antioxidant enzymes. Such a situation is triggered by the emotional stresses already mentioned, and cells are forced into a highly activated state due to loss of control of their regulatory systems.

Such oxidative stress has an adverse depressive effect on the immune system, diminishing its ability to keep the disease under control.

While taking LDN, relapses of MS are much less likely to occur, but exacerbations may again occur when under stress. This should more precisely be referred to as a reactive exacerbation as, in this situation, the increase in symptoms is not directly related to an increase in MS disease activity.

In this circumstance, when MS symptoms are seen to increase significantly, many MS patients will be tempted to accept the routine advice of conventional neurologists, which is to submit to a course of steroid drugs. This choice remains debatable, when a simpler alternative, used early enough, may be more beneficial without resorting to such powerful drugs.

Steroid use in any autoimmune disease such as MS has a strong adverse effect, suppressing both the immune system and adrenal function. Thus, when the steroids are stopped, these actions cause an increase in both the risk of further relapse, and rate of disease progression. In addition, when steroids are used, it is necessary to stop taking the LDN, further disrupting the level of disease stability. Thus, if a relapse should occur for whatever reason, the most important action is to continue the LDN without a break.

In addition, the nutrient therapy, which is also effective in protecting and promoting the function of the immune system, should be continued at optimum levels.


Relapses or exacerbations in MS are related to oxidative stress, therefore the most obvious therapy is antioxidants. These nutrients include, most importantly, zinc and copper at the dose demanded by the zinc taste test, and all the routine antioxidants, including selenium, vitamin C, vitamin E, and beta-carotene, at optimum dosage. Ideally, this will mean doubling the dose beyond that considered appropriate for routine use. This will provide vitamin C 2000 mg; vitamin E 800 international units; selenium 400 mcg, beta-carotene 30 mg. Vitamin D and EPA fish oil will also be required in this circumstance.

The anthocyanidins are also very effective antioxidants, as they permit the recycling and re-use of both vitamin C and vitamin E within the body. Anthocyanidins, otherwise known as oligomeric pro-anthocyanidins, or OPCs are plant-derived flavonoids that have a powerful antioxidant activity. The recommended dose during a normal state of activity of MS is between 250 and 500 mg/ day. During a significant exacerbation, this dose may be safely increased to as much as 500 to 1000 mg/ day.

Examples of anthocyanidins include pine bark extract, often sold as pycnogenol. As a patented product, for the modest dose provided (usually 30 mg) this is relatively very expensive. Conversely, grape-seed extract is one of the cheapest flavonoids available. Others include green tea extract, rutin, and extracts from many dark-coloured seeds, such as bilberries, blueberries or blackberries. This overall method is far more effective at controlling any increase in disease activity with no threat of further relapse. If a relapse is already well advanced however, with widespread new symptoms, there may be no other choice but to use steroids to rapidly reduce inflammation.

This final choice must remain with the individual concerned in consultation with his or her own doctor, and with consideration of the intensity, duration and stage of the current attack.

Dr Bob Lawrence. MRCS; LRCP