Thomas Berger : Managing Multiple Sclerosis Relapses – From Accurate Diagnosis to Effective Treatment

“The most important prerequisite is to judge whether this is a true relapse or not.” – Thomas Berger

In this short video interview, Thomas Berger explains how to accurately identify and manage relapses in multiple sclerosis, highlighting why correct assessment is fundamental for both acute treatment decisions and long-term disease management.

Watch the interview

How should MS relapses be assessed and treated?

In the interview, Thomas Berger shares a practical, experience-based approach to relapse management, grounded in everyday clinical practice rather than theory alone.

Key points discussed include:

Why confirming a true relapse is the most critical prerequisite before initiating treatment
How to distinguish real relapses from pseudo-relapses
The key time threshold that defines a true relapse
Why even “mild” relapses should never be underestimated
The global standard approach to managing relapses
What to do when first-line treatment isn’t enough
The reality of incomplete recovery, and what treatment is really aiming to achieve

What are the main pitfalls clinicians should avoid when diagnosing or treating acute relapses, and how do you personally approach the decision between treating an acute relapse aggressively versus adopting a watchful waiting approach?

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Key messages from Thomas Berger

Accurately identifying a true relapse is the cornerstone of effective multiple sclerosis management. Not every worsening of symptoms reflects new inflammatory disease activity, and distinguishing true relapses from other causes is essential to avoid unnecessary treatments and inappropriate long-term therapy adjustments.

Relapse assessment requires careful clinical judgment. Persistent symptoms, thoughtful exclusion of potential mimickers, and a clear understanding of functional impact are all central to sound decision-making.

Treatment strategies should be guided by both severity and the patient’s day-to-day functioning. Even seemingly mild relapses can meaningfully affect quality of life and should not be underestimated. While high-dose corticosteroids remain the standard acute approach, escalation strategies may be required in more severe or non-responsive cases. Ultimately, the goal is to control inflammation and reduce relapse-associated disability.