A multiple sclerosis relapse is always a difficult moment to experience, filled with worry and uncertainty. Beyond the often prominent physical symptoms, relapses can also significantly affect cognitive functions. Understanding what is happening, knowing how to react, and how to adapt cognitive stimulation during this period are essential elements for navigating these episodes and optimizing recovery.

What is a relapse and how does it affect cognition?

A MS relapse corresponds to the onset of new neurological symptoms or the worsening of existing symptoms, lasting at least 24 hours, in the absence of fever or infection. It results from acute inflammation in the central nervous system, creating one or more new lesions that disrupt the transmission of nerve signals. Relapses are characteristic of relapsing-remitting forms of MS.

While relapses are often associated with physical symptoms such as vision problems, muscle weakness, or sensory disturbances, they can also affect cognitive functions. A new lesion located in an area involved in cognition can cause difficulties with memory, attention, concentration, or reasoning. Even lesions in other regions can indirectly affect cognition by disrupting interconnected neural networks.

Possible cognitive symptoms during a relapse

Cognitive symptoms during a relapse vary depending on the location of new lesions and the individual's cognitive reserve. Some patients do not experience any cognitive changes during their relapses, while others note significant difficulties. Here are the most frequently reported cognitive symptoms:

• Brain Fog: Feeling like thinking through cotton, difficulty having clear ideas
• Concentration Difficulties: Inability to focus on a task, increased distractibility
• Cognitive Slowing: Processing information more slowly than usual
• Memory Difficulties: More frequent forgetfulness, difficulty retaining new information
• Language Disturbances: Difficulty finding words, confusion in expression
• Major Cognitive Fatigue: Rapid mental exhaustion with minimal intellectual effort

What to do during a relapse?

When a relapse occurs, the priority is to quickly consult your neurologist to assess the situation and decide on a possible treatment. But beyond medical management, certain attitudes can help navigate this difficult period and promote recovery.

Consult and treat if necessary

The standard treatment for relapses is high-dose corticosteroid therapy, usually administered intravenously for 3 to 5 days. Corticosteroids do not necessarily accelerate final recovery but can shorten the duration of the relapse and limit its intensity. The decision to treat depends on the severity of the symptoms and is made with the neurologist.

If you notice significant new cognitive symptoms, mention them to your neurologist. They are part of the relapse picture and deserve to be documented for the follow-up of your disease.

Rest without guilt

During a relapse, the body and brain need rest to fight inflammation and begin the repair process. This is not the time to prove that everything is fine or to maintain your usual pace. Resting is not weakness; it is giving your body the best chance for recovery.

This rest also concerns the brain. If you feel mentally foggy, do not try to force it. Reduce stimulation, avoid demanding cognitive tasks, and give yourself breaks. Your brain needs this energy to manage inflammation and repair.

Managing emotional impact

A relapse is often experienced as a failure, a regression, a source of anxiety for the future. These emotions are normal and legitimate. Allow yourself to feel them without repressing them, but also try to keep perspective: most relapses are followed by partial or complete recovery. This is not the end; it is a difficult episode to navigate.

The support of family, a psychologist, or a patient group can be valuable during this period. Do not hesitate to talk about what you are experiencing and to ask for help if needed.

The recovery phase: gradually resuming

After the acute phase of the relapse, comes the recovery phase which can last several weeks to several months. This is a crucial period where the brain repairs damage, partially remyelinating affected fibers and establishing compensation mechanisms. Cognitive stimulation can play a positive role in this phase, provided it is well dosed.

Gradually resuming cognitive stimulation

Once the acute phase has passed and you feel your energy returning gradually, you can resume cognitive stimulation. The important thing is to be gradual: do not try to make up for lost time or to immediately regain your level before the relapse. Your brain needs time.

• Start with EDITH easy level: Gentle exercises without time pressure to ease back in
• Short sessions: 10-15 minutes maximum at first, gradually increasing
• Listen to your fatigue: Stop at the first signs of mental exhaustion
• Do not compare: Your performance may be temporarily lower, which is normal
• Celebrate small victories: Each completed exercise is a step towards recovery

Cognitive stimulation to promote recovery

Cognitive stimulation during the recovery phase is not only a way to maintain your abilities: it can actively contribute to recovery by stimulating brain plasticity. By engaging cognitive functions, you encourage the brain to create new connections and strengthen alternative compensation pathways.

Studies suggest that early cognitive rehabilitation after a relapse can improve functional recovery. Without being too ambitious, maintaining adapted cognitive activity helps the brain reorganize effectively.

After my last relapse, it took me two months to regain my usual cognitive level. At first, even EDITH easy level fatigued me. I learned to be patient with myself. Gradually, I was able to increase the duration and difficulty. Today, I have regained my previous level, and I am even more aware of the importance of this daily stimulation.

Isabelle, 38 years old, relapsing MS for 6 years

Preventing the cognitive impact of future relapses

While we cannot always prevent the relapses themselves (that is the role of disease-modifying treatments), we can act to limit their cognitive impact and promote better recovery. Building a solid cognitive reserve is the best preventive strategy.

Building your cognitive reserve between relapses

Between relapses, when you are feeling well, it is the time to build and strengthen your cognitive reserve. Regular cognitive stimulation with EDITH and JOE, an intellectually active life, new learning: all of this builds reserves that your brain can draw on during future relapses.

The greater your cognitive reserve, the better your brain will be able to compensate for the effects of future lesions. It is an investment for the future, a form of brain insurance that you build day by day.

Optimizing other pillars of brain health

• Disease-modifying treatment: Take your treatment regularly to reduce the frequency of relapses
• Quality sleep: Good sleep promotes recovery and brain plasticity
• Physical activity: Exercise protects the brain and stimulates the production of neurotrophic factors
• Stress management: Stress can promote relapses and worsen cognitive symptoms
• Balanced diet: Adequate nutrients support neuronal health

EDITH and JOE: allies in managing relapses

The EDITH and JOE programs are particularly suited for managing relapses because they offer great flexibility in difficulty and intensity. You can adapt your use to each phase of the relapse and recovery.

During the acute phase

If you wish to maintain a light cognitive activity even during the relapse, EDITH easy level with very short sessions (5-10 minutes) can be an option. Consider this as a moment of relaxation rather than training. If it is too tiring or frustrating, do not hesitate to take a complete break.

During recovery

EDITH is your ideal ally during the recovery phase. Start with the easy level and gradually increase to intermediate and then difficult levels as you recover. Games without time constraints allow you to work at your own pace without stress.

Between relapses

When you are feeling well, it is the time to use JOE for more challenging exercises that actively build your cognitive reserve. Timed challenges intensely stimulate your brain and prepare it to better withstand future relapses.