Which type of MS you have depends on the presence of relapses.
When it comes to multiple sclerosis, you can’t really look at any one patient’s experience as representative of the condition; that’s because symptoms of MS can vary widely from patient to patient. Depending on where lesions form on the central nervous system, MS may affect different parts of the body for each patient, like the legs, fingers, or vision.
Doctors categorize multiple sclerosis into four main types, based on the progression of the disease. This diagnosis does matter since it can affect treatment. “There are different classifications for MS, and that is really based on the patient’s symptoms and what the patient tells us,” says Michelle Fabian, MD, a neurologist at The Mount Sinai Hospital.
There are four main courses MS can take: progressive-relapsing MS, secondary progressive MS, primary progressive MS, and relapsing-remitting MS.
What Is Relapsing-Remitting MS?
The most common type of MS is relapsing-remitting, affecting 85 percent of MS patients at diagnosis. The key characteristic of this type is relapses, or flare-ups, of MS symptoms, followed by periods of lessened or no symptoms.
Doctors define relapses as a new attack, localized somewhere on the body, that causes symptoms that last longer than 24 hours, according to Dr. Fabian. After the attack, the patient makes a partial or full recovery and may not experience new symptoms for weeks, months, or even years.
Because the patient may not fully recover between relapses, each relapse may exacerbate the condition and increase disability over time. Treating relapsing-remitting MS focuses on preventing relapses, which will keep the condition from progressing. Learn more about relapsing-remitting MS here.
What Is Primary Progressive MS?
Primary progressive MS affects about 15 percent of MS patients at diagnosis, according to the National MS Society. Instead of relapses that come and go, patients with primary progressive MS see a slow and steady progression of their symptoms over time.
“Instead of a new symptom that comes on over days to weeks, it’s a slow thing that happens over months to years,” says Dr. Fabian. “It’s more of a gradual symptom, and then it doesn’t typically go away. It might kind of plateau—flatten out—but it doesn’t go away.”
Learn more about the characteristics of primary progressive MS here.
What Is Secondary Progressive MS?
A patient with relapsing-remitting MS may be diagnosed with secondary progressive MS if, over time, relapses stop occurring and the disease switches to a more gradual worsening of symptoms.
“[Patients with SPMS] have a history of those episodes of [central nervous system] inflammation,” says Dr. Fabian, “but those stop. What happens after that is they develop a progressive course.”
What Is Progressive-Relapsing MS?
This disease course is the rarest of the four, according to Dr. Fabian. Progressive-relapsing MS begins as a progressive course, gradually becoming more severe, and then the patient experiences a relapse—a flare-up of symptoms on a new part of the body.
In addition to the four main types of MS, doctors may also diagnose a patient with clinically isolated syndrome. “We have patients with one symptom of MS, and their MRI looks like a mild form of MS,” says Dr. Fabian. “That would be CIS.” If the patient has another relapse—as many do—doctors would then consider that relapsing-remitting MS. Here’s more information about clinically isolated syndrome.
Thanks to recent treatment advances for MS, most patients with relapsing-remitting MS won’t develop secondary progressive MS, unlike in the past. New medications have become more effective at preventing relapses, thus helping to stave off the progression of the disease.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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MS is an autoimmune disease of
the central nervous system.
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So just to break that down, the immune
system is the system we have in our body
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to protect against virus,
bacteria, any sort of infection.
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And instead of doing that, for some reason
in Multiple Sclerosis, it turns inward.
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There are different classifications for
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that is really based on the patient's
symptoms and what the patient tells us.
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Relapsing-remitting MS is
the most common form of MS.
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Eighty-five percent of people
are diagnosed with it at onset.
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An MS relapse is a patient that has a new
symptom that is somewhere on their body,
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localized on their body and
it lasts longer than 24 hours.
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And it comes on usually over
the course of days to weeks and
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then it goes away over days to weeks.
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The other sort of thing that can
happen in MS is progressive MS.
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Instead of a new symptom that
comes on over days to weeks,
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it's a slow thing that
happens over months to years.
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So it was more of a gradual symptom,
and then it doesn't typically go away.
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It might kind of plateau,
flatten out, but it doesn't go away.
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With primary progressive MS,
they never had a relapse, and
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it's usually just something
that's a little bit insidious.
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It comes on slowly and
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it's usually a walking challenge
that happens over months and years.
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Secondary progressive MS is a patient who
tells us that they did have relapses.
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They have a history of those episodes
of CNS inflammation and but those stop.
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And what happens after that is
they develop a progressive course.
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So a person might have had inflammation
in their eye or numbness and tingling
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that came and went away after some weeks
and that would be usually years before.
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And then they start developing
a worsening that happens over months and
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The rarest type is called
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That means that somebody had
progression for months and years, but
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then they developed a relapse.
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So that's a pretty rare course.
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We have patients with one symptom of MS,
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their MRI looks like a mild form of MS.
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That would be CIS or
clinically isolated syndrome.
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So they've only had one relapse and
then a very mild MRI.
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Some people they don't have enough
lesions on their MRI that we
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can give them the full diagnosis.
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So we call them clinically isolated
syndrome because we know it's part of
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the same condition.
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It's just that they don't have
enough to show it for yet.
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Some people when they look
at our different MS courses
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they think that it's more like cancer
where there's stages one through four.
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It's not like that in MS.
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And so it's really a person with
Relapsing-Remitting MS could either stay
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Relapsing-Remitting forever or they
could develop Secondary Progressive MS.
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A person can have just Primary Progressive
MS if they never had a relapse and
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they just develop progression.
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Most patients now because we
have such good treatments for
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MS, we hope that they're not going to
develop Secondary Progressive MS and so
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hopefully that will be
something we see less and less.
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Frequently asked questions about CIS. New York, NY: National Multiple Sclerosis Society. (Accessed on March 12, 2018 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Clinically-Isolated-Syndrome-(CIS)/FAQs.)Types of MS. New York, NY: National Multiple Sclerosis Society. (Accessed on March 12, 2018 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS)