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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Neurology

How Likely Is Another RRMS Relapse, and Can It Be Predicted?

At a Glance

There is no test that can predict exactly when an RRMS relapse will occur. Neurologists estimate near-term risk from recent relapses, MRI activity, age, and treatment, while disease-modifying therapies lower—but do not eliminate—the risk.

In this answer

4 sections

01

What Influences the Risk of a Future Relapse?

02

How Treatment Impacts Your Risk

03

Why We Can’t Predict the Exact Next Relapse

04

What to Do If You Experience New Symptoms

It is entirely natural to wonder when or if another multiple sclerosis (MS) relapse might happen. While having relapsing-remitting multiple sclerosis (RRMS) means relapses are possible, there is currently no single test or tool that can tell you exactly when or if your next relapse will occur [1][2]. Relapse risk is highly individualized and changes over time based on your age, recent disease activity, and the treatment you are taking [3][4][5].

What Influences the Risk of a Future Relapse?

Several factors give your neurologist clues about your near-term risk of a relapse, though none offer a perfect prediction:

  • Prior Relapse History: An important indicator of your future risk is your recent past. A history of frequent or very recent relapses generally signals a higher risk of having another relapse in the near future [4][6].
  • MRI Activity: Magnetic resonance imaging (MRI) provides a window into “silent” inflammation, meaning disease activity you might not feel. Neurologists look for new or enlarging T2 lesions (areas of prior or current damage) compared to past scans, and gadolinium-enhancing lesions (using a contrast dye to highlight active, new inflammation) [7][6]. When combined with your clinical history, these MRI findings help neurologists estimate the likelihood of future disease activity [7][6].
  • Age: As people with RRMS get older, their immune systems naturally change, and the frequency of inflammatory relapses tends to decrease [5][8]. However, age alone cannot predict your immediate likelihood of a relapse [9]. Additionally, having fewer relapses does not mean the disease has entirely stopped, as disability progression can still occur independently of relapses [10].

How Treatment Impacts Your Risk

Disease-modifying therapies (DMTs) are the most effective way to lower your risk of future relapses [11]. In clinical trials, researchers measure the annualized relapse rate (ARR), which is the average number of relapses a group of patients has per year. Depending on the medication, trials show that DMTs can reduce the ARR by approximately 15–36% (for some older therapies) or 50–69% (for highly effective therapies) compared to a placebo or another drug [12][13][14].

It is important to understand that these numbers are averages from large studies, not a personal prediction of your exact risk. DMTs can significantly reduce, but not completely eliminate, the chance of a relapse [3][15].

Your risk can temporarily increase during “treatment gaps”—such as if you stop taking your medication or experience delays in getting a refill [16][17]. Some specific medications can even cause a “rebound” effect, where disease activity returns strongly if the drug is stopped suddenly [16]. A carefully planned medication switch with your neurologist can often be managed safely, but you should never stop or change your DMT without your neurologist’s guidance.

Why We Can’t Predict the Exact Next Relapse

Forecasting the exact timing of an individual’s next relapse remains challenging [1][2]. Researchers are studying blood tests like neurofilament light chain (NfL), a protein released when nerve cells are damaged. While NfL levels can indicate broad disease activity, they are not specific to MS and do not yet provide a validated, individualized countdown to exactly when a relapse will occur while you are on a DMT [18][19].

What to Do If You Experience New Symptoms

Because exact prediction isn’t possible, it is essential to monitor your body and communicate with your care team.

  • Seek Emergency Care: Do not wait if you experience severe or sudden symptoms like facial drooping, sudden weakness or numbness on one side, speech difficulty, sudden vision loss, or severe imbalance. These are red-flag symptoms that could indicate a stroke or another emergency, requiring immediate medical evaluation.
  • Contact Your MS Team Promptly: For other new or worsening neurological symptoms, contact your neurologist’s office. Neurologists generally define a true MS relapse as new or worsening neurological symptoms lasting at least 24 hours. However, the 24-hour rule is a diagnostic tool for your doctor, not a reason for you to delay reporting your symptoms.
  • Understand Pseudo-Relapses: Your doctor will also help determine if you are having a pseudo-relapse. This is a temporary worsening of old symptoms caused by factors like a fever, infection, or extreme heat, rather than new MS inflammation.

If you do have a confirmed relapse, it does not automatically mean your DMT has failed [20]. Your care team will look at the whole picture—including MRI results, how long you’ve been on the medication, and other factors—before deciding if a treatment change is right for you.

Common questions in this guide

Can doctors predict exactly when my next RRMS relapse will happen?
No. There is currently no single test or tool that can predict exactly when or whether an individual’s next RRMS relapse will occur. Neurologists estimate near-term risk by considering your recent symptoms, MRI findings, age, and treatment.
What factors can make another RRMS relapse more likely?
Frequent or recent relapses, new or enlarging T2 lesions, and gadolinium-enhancing lesions on MRI can suggest higher near-term disease activity. Treatment gaps or delayed refills may also increase risk, while relapse frequency often decreases with age. No single factor provides a perfect prediction.
How do disease-modifying therapies affect RRMS relapse risk?
Disease-modifying therapies can substantially lower the average number of relapses, although the effect varies by medication. Clinical trial results are group averages and do not predict one person’s exact risk. These treatments reduce but do not completely eliminate the possibility of a relapse.
Can stopping or delaying an MS medication increase my relapse risk?
Yes. A treatment gap, missed refill, or sudden stopping of some medications can allow disease activity to return and may sometimes cause a rebound effect. Do not stop or change a disease-modifying therapy without first speaking with your neurologist.
Can an MRI show MS activity even if I feel well?
Yes. New or enlarging T2 lesions and gadolinium-enhancing lesions can show inflammation or disease activity that has not caused noticeable symptoms. Your neurologist uses these findings together with your clinical history to assess future relapse risk and decide how often monitoring is needed.
How can I tell an RRMS relapse from a pseudo-relapse?
A true relapse generally involves new or worsening neurological symptoms lasting at least 24 hours, while a pseudo-relapse is a temporary return or worsening of old symptoms triggered by factors such as fever, infection, or extreme heat. Contact your MS team promptly about new symptoms rather than waiting to see whether they last. Sudden severe weakness, facial drooping, speech difficulty, vision loss, or severe imbalance requires emergency evaluation.

Related questions

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References

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This page explains how clinicians estimate future RRMS relapse risk for informational purposes only and does not constitute medical advice. Contact your neurologist before changing treatment or if new symptoms develop.