K.N.O.W. Home Health - PROGRESSIVE RELAPSING MS

Progressive Relapsing Multiple Sclerosis (PRMS) Patient Education

What is Progressive Relapsing Multiple Sclerosis (PRMS)?

PRMS is a rare form of multiple sclerosis. It means the symptoms slowly get worse over time, but there are also times when symptoms suddenly get much worse (called relapses or flare-ups). After these flare-ups, you may get a little better, but the disease keeps progressing overall.

Causes and Risk Factors

The exact cause is unknown.
It happens because the immune system attacks the nerves’ protective covering (myelin).
Risk factors are similar to other types of MS: being a woman, age 20–50, family history, living farther from the equator, and possible environmental triggers like viruses.

Signs and Symptoms (Early Warning Signs)

Gradual worsening of muscle weakness or stiffness.
Sudden flare-ups causing new or worse symptoms like vision problems, numbness, or trouble walking.
Fatigue or tiredness.
Problems with balance or coordination.
Bladder or bowel difficulties.
Trouble thinking or concentrating.

Complications if Untreated or If You Don’t Follow Treatment

Symptoms may get worse faster.
You may lose the ability to walk or do daily tasks.
Higher risk of falls and injuries.
Increased chance of infections.
Emotional problems like depression or anxiety.

Treatment and Self-Care Measures

There is no cure, but treatments can slow progression and reduce flare-ups.
Follow your treatment plan closely.
Stay physically active, but avoid overheating.
Rest when tired.
Eat a healthy diet.
Manage stress through relaxation or counseling.
Avoid smoking and limit alcohol.
Use assistive devices if needed.

Common Types of Medications

Disease-modifying therapies (DMTs): Help slow disease and reduce relapses.
Steroids: Used during flare-ups to reduce inflammation quickly.
Muscle relaxants: Help reduce stiffness or spasms.
Symptom medications: For fatigue, pain, bladder problems, or mood.

Purpose and Side Effects of Medications

DMTs slow progression and reduce flare-ups but may cause flu-like symptoms or injection site reactions.
Steroids reduce inflammation but can cause mood swings, sleep trouble, or upset stomach.
Muscle relaxants may cause drowsiness or weakness.
Tell your doctor about any side effects.

Dietary Needs

Eat plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats.
Stay hydrated.
Some people may need vitamin D supplements; ask your doctor.
Limit salt, sugar, and processed foods.

Lifestyle Changes

Stay active but avoid overexertion or heat.
Use canes, walkers, or other aids if needed for safety.
Schedule regular rest breaks.
Avoid smoking.
Seek emotional support and join support groups if possible.

Safety Considerations

Remove home hazards to prevent falls.
Use handrails and non-slip mats.
Avoid hot baths or hot weather that can worsen symptoms.
Report new or worsening symptoms quickly.

Prevention and Maintenance Tips

Take medicines as prescribed.
Keep all medical appointments and lab tests.
Manage stress.
Maintain a healthy weight.
Avoid infections by handwashing and vaccines.
Monitor symptoms closely and keep a symptom diary.

Extra Tips to Help Reduce Flare-Ups and Hospital Visits

Keep cool and avoid overheating.
Manage stress with relaxation techniques or counseling.
Keep a symptom diary to notice changes and report them early.
Take medicines exactly as prescribed.
Avoid infections by frequent hand washing and avoiding sick people.
Get enough sleep every night.
Ask family or friends for help when needed

When to Call for Help

Call your Home Health Agency or Doctor if:
- You notice new or worsening symptoms.
- You have fever, chills, or signs of infection.
- You feel very weak or tired.
- You have trouble walking or doing daily activities.
- You have medication side effects.
Go to the Emergency Room if:
- Sudden weakness or numbness on one side of the body.
- Sudden trouble speaking, seeing, or understanding speech.
- Severe vision loss.
- Loss of bladder or bowel control.
- Severe headache or neck stiffness.
- Difficulty breathing or chest pain.

PATIENT HOMEWORK/ASSESSMENT

Please answer True or False and correct All False Statements

True or False: PRMS symptoms get worse gradually but also have sudden flare-ups.
True or False: PRMS is the most common type of multiple sclerosis.
True or False: Fatigue is a common symptom of PRMS.
True or False: Steroids can help during flare-ups of PRMS.
True or False: Smoking does not affect PRMS.
True or False: Diet has no impact on managing PRMS symptoms.
True or False: Disease-modifying therapies can slow down PRMS progression.
True or False: You should avoid exercise if you have PRMS.
True or False: Muscle relaxants may be prescribed to help with stiffness.
True or False: Hot tubs and saunas are safe for people with PRMS.
True or False: You should report new numbness or weakness to your doctor immediately.
True or False: It is important to attend all medical appointments for PRMS.
True or False: PRMS symptoms never get better after flare-ups.
True or False: Managing stress can help reduce flare-ups.
True or False: PRMS only affects men.
True or False: Using assistive devices can help prevent falls.
True or False: Vitamin D might be helpful in managing MS symptoms.
True or False: You should stop medications once symptoms improve.
True or False: Infections can worsen PRMS symptoms.
True or False: Sudden loss of speech or vision requires emergency care.

Individualized Questions to Ask Your Doctor or Healthcare Team

What type of PRMS do I have, and what should I expect?
What lab tests or imaging will I need and how often?
Are my current medications effective and what side effects should I watch for?
What changes should I make in my diet to support my health?
How can I safely manage fatigue and stay active?
What are the early signs that my PRMS is getting worse?
How can I reduce the number of flare-ups?
What vaccines or precautions should I take to avoid infections?
What support services can help me at home?

Answer Key for PRMS True/False Questions

True
PRMS symptoms get worse gradually over time but also have sudden flare-ups (relapses) that cause new or worse symptoms.
False
PRMS is a rare type of MS, not the most common. Relapsing-Remitting MS is the most common type.
True
Fatigue is a common symptom in PRMS and all types of MS.
True
Steroids are used during flare-ups to reduce inflammation and help symptoms improve faster.
False
Smoking worsens MS, including PRMS, and can increase flare-ups.
False
Diet and good nutrition support overall health and symptom management in MS.
True
Disease-modifying therapies (DMTs) can slow down disease progression and reduce flare-ups.
False
Exercise is important and helpful; it improves strength and function but should be done safely.
True
Muscle relaxants can help reduce muscle stiffness and spasms in PRMS.
False
Hot tubs and saunas raise body temperature, which can worsen MS symptoms.
True
New or worsening numbness or weakness should be reported to your doctor immediately.
True
Regular medical appointments are important to monitor and manage PRMS.
False
Symptoms may improve somewhat after flare-ups, but the overall trend in PRMS is worsening over time.
True
Stress can trigger or worsen flare-ups, so managing stress is important.
False
PRMS affects both men and women, though MS overall is more common in women.
True
Assistive devices like canes or walkers help prevent falls and improve safety.
True
Some research shows vitamin D might help manage MS symptoms; check with your doctor.
False
You should not stop medications without consulting your doctor, even if symptoms improve.
True
Infections can trigger flare-ups or worsen MS symptoms.
True
Sudden loss of speech or vision is a medical emergency and requires immediate care.