Multiple sclerosis (MS) is a progressive inflammatory disease of the Central Nervous System (CNS) that is often disabling and unpredictable. While everyone with the disease experiences nerve damage, each person is affected by MS in different ways. Due to the extensive variation of symptoms and rates of disease progression, doctors have identified four different types of MS: clinically isolated syndrome (CIS), relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS), and primary progressive multiple sclerosis (PPMS). As a result of these disease categories, doctors are better able to determine the right treatment options for each patient.
Clinically isolated syndrome (CIS) is the first episode of neurological symptoms associated with MS, and has a duration of at least 24 hours. Symptoms that occur during this first episode may include muscle weakness, dizziness, numbness, blurry vision, problems with balance, and others. However, not everyone who experiences CIS will go on to develop MS. Doctors can undergo a risk assessment on patients with an MRI scan; the more lesions that are seen on the brain or spinal cord, the greater the likelihood that MS will develop. Patients who have lesions may be prescribed medication which can help to prevent or delay the onset of the disease (National Multiple Sclerosis Society).
Relapsing-remitting multiple sclerosis (RRMS) is the most common form of MS, which affects about 85% of people with the disease. This form of MS is characterized by an attack or exacerbation of symptoms, known as a relapse, which is then followed by a period of partial or full recovery, which is known as a remission. Symptoms typically emerge over the course of several days and then improve over a period of weeks or months. RRMS is highly unpredictable since relapses can occur at any time, even after years of remission. People who develop RRMS are typically diagnosed in their 20s or 30s (Leifer, 2018).
Secondary progressive multiple sclerosis (SPMS) affects approximately half of people that are diagnosed with relapsing-remitting MS. Most people who progress to this form of the illness transition to it within the course of ten years from their initial diagnosis. During SPMS, most people’s symptoms worsen steadily over time without alternating periods of relapse and remission, due to a gradual deterioration of neurological function (Leifer, 2018). However, each person experiences SPMS differently, and some may still have occasional relapses and remission.
Primary progressive multiple sclerosis (PPMS) is a rarer form of the disease that affects up to 15% of people with MS. Unlike with RRMS, people who experience this type of MS are typically diagnosed later in life. This version of the disease is characterized by a steady worsening of symptoms without relapses or remissions. The pace of disease progression and intensity of symptoms can vary greatly among people with PPMS. While only one drug, ocrelizumab (Ocrevus), has thus far been approved for treatment of PPMS, other medications can be used to help alleviate symptoms. Moreover, different types of therapy (occupational, physical, speech) can be used to help treat the condition (Leifer, 2018).
Understanding the various forms of MS is critical for those who have the illness, as it can help them to know what the best treatments are; as well as, what to expect from their doctors.
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References:
Types of MS. (n.d.). National Multiple Sclerosis Society. Retrieved February 11, 2019, from https://www.nationalmssociety.org/What-is-MS/Types-of-MS
Leifer, M. (2018). The Four Types of MS. WebMD Living Well with Multiple Sclerosis, 10.