Multiple sclerosis is a chronic inflammatory autoimmune condition that causes axonal demyelination and neural dysfunction. It is the most prevalent non-traumatic disabling condition in young adults, with a prevalence of over 2 million cases worldwide. Patients are classified into different subtypes based on their clinical course. The majority of cases have the Relapsing-remitting form that is characterized by acute exacerbation also known as flare-ups. Which could have an immense toll on patients’ physical and emotional health. acute multiple sclerosis flare-ups and their management.PubMed database was used for articles selection, papers were then obtained and reviewed. Multiple sclerosis flare-ups can vary dramatically in their presentation and severity from one patient to other. Establishing a diagnosis of an acute flare-up is mainly clinical but could be supported by MRI findings of a gadolinium-enhancing lesion. Pseudo-relapses are a group of numerous conditions that can lead to acute worsening of the patient symptoms mimicking a true relapse, therefore physicians should take active measures to confirm the absence of such conditions. Treatment should be offered for patients with disabling symptoms or if impaired daily function. First-line therapies are glucocorticoids or ACTH injection gels as both have similar efficacy and relatively safe profile, as for irresponsive cases a trial of either plasma exchange or immunoadsorption could be tried.