Hi Poppy,
It is simply not possible to have three separate relapses in a week. A relapse lasts a minimum of 24 hours, but an average one lasts five weeks, and they can last a lot longer (I’ve had one lasting almost a year).
However long they last (even if it’s the shortest possible, at 24 hours), there still has to be the “clear” 30 days between the end of one and the start of the next for them for them to officially be counted as separate relapses, and that’s why you could not fit three into a week, or even into a month. Three “happenings” of some sort in one week is not three separate relapses, but all part of the same one. You can have better and worse days, and more than one set of symptoms, even during the same relapse. So feeling better for a couple of days, but then starting with something else doesn’t mean you got over one relapse and started another. It means the same relapse has multiple consequences.
For most purposes it’s pretty academic, but counting the number and frequency of relapses can become important when consultants consider which treatments are most suitable. It used to be the rule-of-thumb (seemingly not so strictly enforced now) that you needed at least two relapses in any two year window to qualify for any disease modifying drugs at all.
You couldn’t achieve a count of three for a single week, because obviously there couldn’t be the 30 days’ remission that applies before they reset the count. So all the incidents of that week, and indeed any others that occurred within a further 30 days would all be treated as part of a single MS episode, or relapse. If things calmed down and you had 30 good days (not necessarily symptom free, but no new symptoms, and no sudden flare-ups of the old ones), but then started again with a new symptom or crop of symptoms, that would be counted as a new relapse, so now up to two for that year.
You can certainly have multiple symptoms in a week, because a relapse typically consists of multiple lesions, which each have their own effects, but it’s not one symptom (or even one lesion) per relapse. A relapse can last a long time, and have multiple symptoms and lesions. E.g. you could have problems with both eyesight and walking in the same month, but that wouldn’t be “the eyesight relapse” and “the walking relapse”. It would be one relapse that happens to have affected both.
Your neuro may have been able to deduce you’d had it a long time from (a) sheer number of lesions, making it unlikely they’d all arrived recently, and/or (b) doing an MRI with contrast, which revealed a mixture of active (current) and historic lesions. If only some of them are active, but the rest are old, then by definition, they can’t all have got there at the same time. You must have had at least two relapses - one responsible for the old lesions, and one responsible for the current ones.
Unfortunately, contrast can only tell the difference between old and current. It can’t distinguish different ages of the old ones, so there’s no way of telling if they came from just a single previous relapse, or several. It would be nice to know, but technology just can’t give us that information.
When I discovered I had lesions at all, I asked the neuro outright: “We can’t tell how long these have been there, can we?”, and he admitted: “No.”
So really the only things that give a clue are how long the patient’s been having symptoms, and how many total lesions they have - more usually pointing to them having it longer.
Mine was a weird one, because I had comparatively few lesions (just six, at first scan, which I was told was good), but a long history of symptoms. This was interpreted as good news, because if I’d really had symptoms for years, but still had only six lesions, it was a sign it was either not very aggressive, OR I’d been recovering really well - either of which was good.
I had more than six by the time I was diagnosed, but they didn’t tell me how many, and I didn’t ask. I knew if they didn’t tell me, it could only be because I wouldn’t like the answer. So I’ve learnt a good strategy is not to ask anything I know I wouldn’t like the answer to.
Lesion count is not a very accurate predictor of disability anyway, so if I’d asked and been told a high number, I’d probably have panicked needlessly. How you feel is still a much better guide than an arbitrary count of lesions, though the latter still has its uses as a guide to disease activity, and whether a particular treatment is working or not. It’s not a good guide to how you should be feeling, though.
Tina
x
(I’ll forgive the serenading lol)