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As someone who has been Living with multiple sclerosis (MS), for over 30 years, I can attest that it often means facing uncertainty. For some, the most frustrating reality is not weakness, numbness, or pain, but the fact that fluctuating symptoms MS bring inconsistency into daily life. A good day can turn bad without warning. A symptom flare may vanish as suddenly as it appeared. To the outside world, this unpredictability is puzzling — and sometimes, dismissive comments arise: “But she looked fine yesterday.”

I can further confirm that if I push through the pain and fatigue to go out and be told by a well-meaning neighbour that “You are looking well today” is very infuriating. I can only mutter. “You can’t see what’s inside.”

The fable below captures that misunderstanding. Afterwards, we’ll explore the science, triggers, and personal impact of symptoms that come and go, and how to find balance in a condition that often feels like a moving target.

The Fable: She Looked Fine Yesterday

Anna was known for her bright smile. On Monday, she strolled to the bakery, carried her shopping, and chatted with neighbours. On Tuesday, she could barely make it from her bed to the kitchen. Whispers followed: “But she looked fine yesterday…”

Her community thought she exaggerated her problems. Some believed she was lazy. Others thought she was seeking sympathy. Yet the truth was that Anna lived with an unpredictable illness. Her body played by rules no one else could see. Some days, strength returned. Other days, it deserted her without warning.

In time, Anna realised that explaining her reality was not a weakness but a strength. She told her friends: “I have good days and bad days. Yesterday I looked fine. Today I’m not. Both are real.” Gradually, understanding replaced doubt. The lesson spread: appearances never tell the whole story.

Invisible Patterns: Why Fluctuating Symptoms MS Happen

Nerve Pathways and the Central Nervous System

The brain and spinal cord control every movement, sensation, and thought. In MS, damage to the protective myelin covering disrupts these signals. This disruption does not stay constant. It can fluctuate throughout the day depending on factors such as temperature, fatigue, and stress.

• Nerve fibres may sometimes work, other times misfire. Unlike muscles that strengthen with exercise. nerves can weaken with overuse.
• Multiple sclerosis MS lesions can create “bottlenecks” that worsen under pressure. Lesions can be likened to sand dunes – forever shifting.
• Small shifts — like overheating or sleep loss — can push symptoms into a flare.

External resource: Do MS Symptoms Come And Go?

Symptoms That Worsen During the Day

Not all MS symptoms are constant. In fact, many people report their symptoms fluctuate throughout the day, influenced by body rhythms. I have seen them alter over longer time-frames. A symptom that leaves me tired and irritable can persist for a few weeks and then vanish completely.

• Fatigue is often worse in the afternoon. This is apparent in my lack of concentration latter in the day.
• Spasticity may increase toward evening (Spasticity and Multiple Sclerosis). I recall watching a medical drama where the doctor observed a patient with twitching legs, He called the symptom myoclonic jerk.
• Restless legs disturb sleep, worsening fatigue by morning (Restless legs syndrome in multiple sclerosis patients).

This pattern explains why a person might seem capable at one time of day but drained at another — fuelling the refrain, “She looked fine yesterday.”

External resource: MS Symptoms Fluctuate During the Day

MS Symptoms That Worsen with Triggers

Symptom flare is not always a relapse. Instead, symptoms often worsen temporarily due to triggers:

• Heat: Sun exposure, exercise, or hot showers. I find it counterintuitive when a medic tells me I should exercise more.
• Stress: Emotional strain intensifies fatigue and cognitive fog. Sometime the most innocuous situations can stress you, leading to a symptom flare.
• Poor Sleep: Lack of rest magnifies brain fog and physical weakness. The old adage that “sleep cures all” does not seem to fit.

For more on disrupted rest: Common Sleep Disorders and Multiple Sclerosis

This explains why two consecutive days may look completely different: one day steady, the next unstable.

Are the MS Symptoms Always Unpredictable?

Yes — but with patterns. Fluctuating symptoms MS are unpredictable in timing but often tied to underlying causes. Recognising these patterns helps in managing them.

External resource: Tracking daily fatigue fluctuations

• Good day bad day cycles may reflect energy thresholds.
• Relapse remission patterns are larger cycles, spanning weeks or months.
• Paroxysmal symptoms are sudden, short-lived bursts — painful shocks, tremors, or spasms (Paroxysmal symptoms).

Understanding these categories helps patients explain their condition to others and helps doctors fine-tune care.

Emotional Weight of Inconsistency

The social burden of inconsistency is often heavier than the physical. People with MS report feeling judged when they cancel plans after being active the day before. The constant refrain, “But she looked fine yesterday,” undermines confidence.

Yet truth-telling, as in Anna’s story, builds bridges. Explaining that MS symptoms fluctuate throughout time helps transform scepticism into empathy.

Internal Link: Energy Management

Coping with Fluctuating Symptoms MS

Practical Strategies

• Pacing: Balancing activity and rest prevents overexertion.
• Cooling techniques: Fans, cooling vests, or cold drinks ease heat-related flares.
• Sleep hygiene: Consistent routines reduce fatigue spikes.
• Journaling: Tracking symptom patterns helps predict triggers.

External resource: Do MS Symptoms Come And Go?

The Role of Support Networks

Support groups and online communities help normalise the ups and downs of MS. Sharing experiences makes it easier to face the reality of an unpredictable illness.

Internal Link: Foot Drop Chair

Medical Approaches

Doctors increasingly recognise that symptoms of multiple sclerosis don’t stay static. Neurologists track fluctuations using clinical review, fatigue scales, and sometimes wearable technology. While treatment focuses on reducing relapses, symptom management is just as vital.

External resource: Paroxysmal symptoms

Internal Link: MS Time Perception

When MS Symptoms Fluctuate Throughout the Day

Daily patterns are important. MS symptoms fluctuate throughout the day due to circadian rhythms and activity levels. Recognising these patterns allows better planning:

• Morning clarity: Use early energy for demanding tasks.
• Afternoon fatigue: Schedule rest or light tasks.
• Evening spasticity: Stretching or physiotherapy can help.

This predictability, even within unpredictability, can restore a sense of control.

Internal link: Sleep Problems MS

Relapse vs Fluctuation

It’s crucial to distinguish relapse from fluctuation. Relapse means new or worsening symptoms lasting more than 24 hours, often requiring medical attention. Fluctuations are temporary worsening tied to triggers or fatigue.

Knowing the difference helps avoid panic while still encouraging vigilance.

Video Resource: MS Symptoms That Fluctuate

‘Making Sense of MS’ produced a useful video showing real patient experiences of good day/bad day cycles.

Conclusion

The fable of “She Looked Fine Yesterday” highlights a truth many face in silence: the unpredictability of fluctuating symptoms MS. From good day bad day cycles to relapse remission phases, from brief paroxysmal symptoms to fatigue that drifts in and out, the reality is that appearances rarely tell the whole story.

By understanding that MS symptoms fluctuate throughout the day, society can move from doubt to empathy. By pacing, tracking, and sharing openly, people living with MS reclaim dignity from an illness that too often hides behind invisibility.

The final lesson: You don’t have to look ill to be struggling. And you don’t have to look fine to be strong.