What are the types of multiple sclerosis (MS)?

Each case of multiple sclerosis (MS) displays one of several patterns of presentation and subsequent course. Most commonly, MS first manifests itself as a series of attacks followed by complete or partial remissions as symptoms mysteriously lessen only to return later after a period of stability. This is called relapsing-remitting (RR) MS. Primary-progressive (PP) MS is characterized by a gradual clinical decline with no distinct remissions, although there may be temporary plateaus or minor relief from symptoms. Secondary-progressive (SP) MS begins with an RR course followed by a later PP course. Rarely, patients may have a progressive-relapsing (PR) course, in which the disease takes a progressive path punctuated by acute attacks. PP, SP, and PR are sometimes lumped together and called chronic progressive MS.

In addition, 20 percent of the MS population has a benign form of the disease, in which symptoms show little or no progression after the initial attack; these patients remain fully functional. A few patients experience malignant MS, defined as a swift and relentless decline resulting in significant disability or even death shortly after disease onset. However, MS is rarely fatal, and most people with MS have a fairly normal life expectancy.

Studies throughout the world are causing investigators to redefine the natural course of the disease. These studies use a technique called magnetic resonance imaging (MRI) to visualize the evolution of MS lesions in the white matter of the brain. Bright spots on a T2 MRI scan indicate the presence of lesions but do not provide information about when they developed.

Because investigators speculate that the breakdown of the blood-brain barrier is the first step in the development of MS lesions, it is important to distinguish new lesions from old. To do this, physicians give patients injections of gadolinium, a chemical contrast agent that normally does not cross the blood-brain barrier, before performing a scan. On this type of scan, called T1, the appearance of bright areas indicates periods of recent disease activity. The ability to estimate the age of lesions through MRI has allowed investigators to show that in some patients, lesions occur frequently throughout the course of the disease even when no symptoms are present.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

The general types, or courses, of multiple sclerosis (MS) are as follows:

  • Relapsing-remitting MS (RRMS): This is the most common course of the disease at the time of diagnosis, affecting 85 percent of patients at this stage. People with this pattern of MS experience clearly defined exacerbations or relapses, followed by partial or complete remissions (or recovery periods) where the disease stops progressing.
  • Secondary progressive MS: Secondary progressive MS (SPMS) follows a course of relapsing-remitting MS; according to the National Multiple Sclerosis Society, most people with RRMS eventually transition to the SPMS form, where neurologic function progressively worsens over time. SPMS can be characterized as active or not active, as well as with progression or without progression. Active SPMS consists of relapses and/or new MRI activity. When SPMS is not active, there is no activity. SPMS with progression indicates there is evidence of disease or worsening of symptoms. When it is classified as without progression, the disease is not changing over time.
  • Primary progressive MS: This pattern of MS is characterized from the onset by a nearly continuous worsening of the disease, with no distinct relapses or remissions. There may be temporary plateaus with minor relief from symptoms but no long-lasting relief. About 15 percent of people with MS have primary progressive MS.

MS varies so greatly in each individual that it is hard to predict the course the disease might take. However, some studies show that people who have few attacks in the first five years following a positive diagnosis of MS, long intervals between attacks, complete recoveries and attacks that are sensory only in nature generally have a less debilitating form of the disease.

On the other hand, people who have early symptoms that include tremors, lack of coordination or frequent attacks with incomplete recoveries generally have a more progressive form of MS. These early symptoms indicate that more myelin (the fatty insulation surrounding nerve cells in the brain and spinal cord) has been damaged.

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There are four types of multiple sclerosis (MS): relapsing-remitting, relapsing progressive, secondary progressive and primary progressive. Most people are diagnosed with relapsing-remitting MS. With this form of MS, people have exacerbations which cause temporary neurologic problems such as weakness, numbness and imbalance. After the exacerbation is over they return, more or less, to their baseline neurologic status. This form of MS can go on for years.

A small minority will be diagnosed with primary progressive MS, in which there are minimal or no exacerbations but a slow, steady decline in neurologic status, primarily in walking ability.

Secondary progressive MS tends to develop after people have had MS for many years and begin to see less in the way of exacerbations and more permanent disability.

With relapsing progressive MS, people continue to have intermittent exacerbations but begin to see accumulated disability.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system where communication between the brain and other parts of the body is disrupted due to a break down in the insulating myelin that surrounds a person's nerves.

There are four commonly-discussed disease courses for MS. For those newly diagnosed, it may not be clear what type you have for some time.

  • Relapsing/Remitting. The majority of people diagnosed with MS—approximately 90%—are diagnosed with the relapsing/remitting type. The symptoms affect most people in their early 20s, after which there are periodic attacks (relapses), followed by partial or complete recovery (remissions). A relapse can last for a few days to several months. The severity can also vary. Symptoms may remain after relapse due to nerve damage. The pattern of nerves affected, severity of attacks, degree of recovery, and time between relapses all vary widely from person to person. Eventually, most people with relapsing/remitting MS will enter a secondary progressive phase of MS.
  • Secondary Progressive. People with this type of MS may have started with a diagnosis of relapsing/remitting and then started to experience a worsening of symptoms over many years. In this type of MS, the course of symptoms steadily progress, without relapses or remissions. The transition typically occurs between 10 and 20 years after the diagnosis of relapsing/remitting MS. Progression occurs at a different rate in each person and generally leads to some disability.
  • Primary Progressive. In this form of MS, the disease begins with a slow progression of neurological deficits where symptoms appear and gradually worsen over time, without significant plateaus or remissions. A person with primary progressive MS, by definition, does not experience acute attacks.
  • Progressive Relapsing. Progressive relapsing MS is the least common form of disease—approximately 5 percent of people with MS have this form. Relapses or attacks occur periodically. However, symptoms continue and are progressive in between relapses.

The above list represents very broad categories for MS. It does not definitively or adequately describe the experiences everyone has with the disease. It is difficult to predict who will remain relatively stable over time and who will progress or how quickly. The final stages of MS vary greatly for each individual with the disease, although most will see an increase in symptoms.

The symptoms of multiple sclerosis (MS) can be varied, so it's difficult to diagnose; but early treatment and lifestyle changes can proactively shift the course of the disease. In this video, neurologist Kulreet Chaudhary, MD, explains this concept.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.