What Are The Four Types Of Ms – Over the past few decades, the quality of life and life expectancy of people with multiple sclerosis (MS) has improved significantly. Multiple sclerosis is a neurological condition that affects nearly one million American adults. New drugs have slowed the progression of the condition.
However, people will usually experience progression and worsening of MS symptoms throughout their lives. There are four stages/types of MS progression:
What Are The Four Types Of Ms
There is no set timeline or one MS course, but knowing the stages can help you understand and manage your MS.
What Are The 4 Types Of Ms?
Disease progression in multiple sclerosis can also be measured in the Disability Status Scale (EDSS). This scale measures how MS affects eight functional systems:
People in the early stages of MS may experience mild symptoms in only one or two functional systems. As MS progresses, more systems are affected, and more systems are affected.
MS does not mean you will advance in every status on the EDSS. In fact, two-thirds of people with MS will retain their ability to walk and never pass stage 7.
Symptoms of moderate disability in one functional system, or mild disability in three or four functional systems. There is no difficulty in walking.
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Significant disability but able to perform self-care activities and live independently. Can walk unaided or at rest for at least 500 meters (1,640 feet).
Significant disability and specific limitations to the ability to perform daily tasks. Can still work and do most activities independently. Can walk unaided or at rest for at least 300 meters (984 feet).
The disability is significant enough to affect daily activities. May need help to work or perform personal care. Can walk with or without assistance at least 200 meters (656 feet).
The disability is significant enough that self-care and other daily activities cannot be performed. Can walk unaided or at rest for at least 100 meters (328 feet).
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Uses a wheelchair exclusively but can transfer himself in and out of a wheelchair. Able to use a wheelchair independently. Can no longer walk more than 5 meters (16 feet) even with assistance.
You may need help getting in and out of a wheelchair. May require a motorized wheelchair. Cannot walk more than a few steps.
Each MS timeline is unique to a person with MS. Not everyone who receives a diagnosis of MS will progress at the same rate or experience all stages.
For example, some people with relapsing-remitting multiple sclerosis (RRMS) never progress to any other form of multiple sclerosis. They may not have severe symptoms or see any progression of their MS. Others may see their symptoms worsen.
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Clinically isolated syndrome (CIS) is diagnosed after a single episode of symptoms. The discharge that leads to a CIS diagnosis results in inflammation and damage to nerve myelin in the brain or spinal cord. It lasts at least 24 hours and causes neurological symptoms, such as:
You will likely have an MRI to help your doctor diagnose MS. Your condition will be classified as CIS if your MRI shows only one area of myelin damage. However, if the MRI shows more than one area of myelin damage, you will be diagnosed with a different classification of MS.
About 85 percent of people with MS are initially diagnosed with relapsing multiple sclerosis (RRMS). RRMS follows a pattern. You will experience definite and predictable symptoms or relapses. You will also experience a period of remission when your symptoms will not be present.
Over time, the symptoms you experience with an attack may worsen. Your MS may be more difficult to treat and manage. You may still experience some symptoms during remission. However, progression only occurs during relapse. Your MS will not progress during RRMS remission.
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RRMS can progress to secondary progressive multiple sclerosis (SPMS). Usually, this happens within 10 years of the initial MS diagnosis, but any non-RRMS case will progress to SPMS. In SPMS MS you will continue to advance. You may still have periods of remission, but your symptoms will worsen with each relapse.
The symptoms of RRMS and SPMS are similar, but the progression looks very different. Worsening symptoms are the main difference between RRMS and SPMS. In RRMS you may experience the same symptoms with the same severity at each relapse for years. In SPMS all relapses will increase in severity.
Disease progression in PPMS is slow and steady. There is no grace period. These symptoms may level off for a period of time and become easier to manage, but they will not go away. Increasing difficulty is very common in PPMS. The exact rate of progress depends on your individual case.
There are various treatment options. You may be advised to make lifestyle changes, take over-the-counter (OTC) medications or take prescription medications. The best treatment plan will depend on your symptoms and how your MS progresses. Your doctor will work with you to find a treatment plan that is right for you.
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An MS diagnosis can be overwhelming. It’s important to find support as you learn to manage your condition. Some interesting places to turn include:
MS is a chronic condition that can change and progress over time. Not everyone with MS will go through every stage of progression, and there is no set timeline. Knowing your MS stage can help you know what to expect and help you manage your condition.
There is no cure for MS, but you can slow the progression and get relief from symptoms with a treatment plan.
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Our experts are constantly monitoring the health and wellness field, and we update our articles when new information becomes available. Relapsing-remitting multiple sclerosis (RRMS) About 85% of people are diagnosed with RRMS Primary progressive multiple sclerosis (PPMS) About 15% of people develop it Secondary progressive multiple sclerosis (SPMS) Most people diagnosed with RRMS will eventually progress to SPMS. four known types of multiple sclerosis: Clinically isolated syndrome: CIS is the first episode of neurological symptoms caused by inflammation and demyelination in the central nervous system. It is typical of multiple sclerosis but does not yet meet the criteria for a diagnosis of multiple sclerosis. When CIS is accompanied by brain lesions on MRI similar to those seen in multiple sclerosis, the person has a high probability of having a second attack and a diagnosis of multiple sclerosis. When there are no brain lesions, the odds are much lower. Relapsing-remitting multiple sclerosis: People with this type of multiple sclerosis experience clear attacks (also called relapses or exacerbations). This is an episode of acute exacerbation followed by a period of partial or complete recovery (remission) without disease progression. RRMS can be further characterized as active (with lesion activity and/or recurrence) or inactive and exacerbation (increased disability due to incomplete resolution of symptoms after relapse) or non-exacerbation. Frequency: The most common form of MS at the time of initial diagnosis. About 85%. Primary-Progressive: People with this type of MS experience a slow but almost continuous deterioration of their disease from the onset of symptoms, with no clear relapses or remissions. However, there are changes in the rate of progress over time, occasional levels and slight temporary increases. PPMS can be further characterized as active (with MRI activity and/or recurrence) or inactive and progressive (showing a confirmed increase in disability over a period of time) or non-progressive. Frequency: About 15% of people are diagnosed with PPMS. Secondary-progressive: People with this type of MS experience an initial period of relapsing-remitting MS, followed by a worsening disease course with or without occasional flare-ups, mild recovery (remission) or plateaus. Frequency: Most people with relapsing-remitting MS will eventually progress to SPMS, although early and continued treatment with disease-modifying therapy has been shown to delay SPMS in most people.
Purple arrows indicate new lesion activity on MRI. MRI activity can occur very early in the course of the disease, even before a person notices any symptoms. Over time, RRMS can be active, with new (light blue) and/or recurrent (orange) MRI activity. Exacerbation may occur when symptoms do not fully resolve following a relapse (dark red), resulting in cumulative disability. A period of stability can also occur, when no new or recurrent MRI activity occurs (dark blue). Lublin et al., 2014
4 Primary progressive multiple sclerosis is characterized by the development of disability from the onset of symptoms, without early relapse. PPMS can have periods when it is active, with evidence of new or old MRI activity and progression of disability (dark red) or active without any progression of disability (light blue). Disability progression can also occur in PPMS without new or recurrent MRI activity (green). Menstruation is stable occasionally, without any MRI activity or recurrence (dark blue). People previously diagnosed with relapsing-remitting multiple sclerosis will now be considered to have active PPMS. Lublin et al., 2014
5 This graph shows that secondary progressive MS follows relapsing-remitting MS.