The Stages and Types of MS

Multiple sclerosis presents in very different ways in different patients, and several different categories of the illness have been defined. The most common way to categorize MS, however, is to track the course of the illness over time. About 90 percent of patients with MS are initially diagnosed with relapsing-remitting MS (RRMS). 

What does this mean? This refers to the tendency of a symptom of MS to come seemingly out of nowhere (a relapse) and then to abate with or without treatment (a remission). Usually patients recover well from relapses, but it is not at all unusual for patients to be left with some residual symptoms. There can be a high degree of variability in the specific symptoms of a relapse, the frequency of relapses, the severity of relapses, and the degree of recovery from relapses. But as long as patients are experiencing relapses without progression of their symptoms in between, they are considered to have RRMS. 

Almost all of the treatments available for MS have been studied and approved for this early stage of the illness. So it is very important that a neurologist spends time talking with their patient to understand not only their current symptoms, but when they began and how they may have progressed over the years.  

After 10 to 20 years after diagnosis is when most patients enter what is called the secondary progressive phase (SPMS). In SPMS, relapses either disappear completely or are quite infrequent.  Yet, there is a slow but steady accumulation of disability. Patients in this stage of the illness may tell you that one year ago they could walk 10 city blocks before needing a rest, and now they can walk only eight. There is no formal transition between RRMS and SPMS, nor are there laboratory tests or radiographic tests to distinguish between the two stages of the illness. Again, the SPMS stage of the illness can only be determined by talking to and examining patients. 

Unfortunately, it is in the progressive phase of the illness that most disability accumulates, and this is the stage of the illness where treatments are most needed. As with relapsing-remitting disease, however, there is a huge range of disability, and a fair number of patients experience little or no progression.

Although seemingly counterintuitive, sometimes the best way to help patients in the progressive phase of MS is to resist the temptation to do something. In some cases, it may even be best to stop MS medications, as at this point, they are likely no longer of benefit to the patient.