Relapsing-remitting multiple sclerosis (RRMS) is the most common form of multiple sclerosis (MS). MS is an autoimmune disease that causes inflammation of the insulating membranes (myelin) that surround nerves within the central nervous system.
In RRMS, there are clear episodes of inflammatory activity (relapses). During a relapse, there are new or worsening symptoms. Relapses are also called attacks, flare-ups, or exacerbations. Relapses are followed by remission, during which the disease does not progress. Residual symptoms may remain during remission. People with RRMS may go on to develop a progressive form of the disease.
Symptoms are extremely variable in RRMS. Overwhelming fatigue is a common debilitating symptom. One of the first signs of MS may be double vision or partial blindness. Other symptoms include numbness, spasticity, and balance issues. This can make walking difficult. Some people experience bladder or bowel dysfunction, vertigo, or pain. In some cases, emotional changes or cognitive dysfunction can occur.
Symptoms of MS tend to worsen when patients become overheated. Lhermitte’s sign is a sensation similar to an electric shock radiating down from the neck. Another strange sensation, called the MS Hug, feels like a tightening around the torso.
During a period of acute inflammation, old symptoms may worsen and new symptoms may appear. A relapse is when active inflammation, and the resulting symptoms, last more than 24 hours. Relapses can continue anywhere from a few days to several months. A relapse may be fairly mild or severe enough to require hospitalization. Following a relapse, there may be a full recovery and return to baseline. In some cases, certain symptoms linger for a longer period of time.
There is no single definitive test for any type of MS. Diagnosis can be a lengthy process and involves detailed patient history and neurological evaluation. A series of tests help doctors rule out other autoimmune and neurological diseases with similar symptoms. Diagnostic testing may include spinal fluid analysis and nerve conduction studies. An MRI of the brain and spine can confirm the presence of lesions. According to theNational MS Society, about 85 percent of people who have MS are diagnosed with RRMS at the outset. It is usually diagnosed earlier than other forms of MS.
Doctors aren’t required to report or track MS, so figures are only estimates. RRMS can occur at any age, but is most often diagnosed between the ages of 20 and 50. According to the National MS Society, women get RRMS two to three times more often than men. About 85 percent of people with MS are initially diagnosed with RRMS. Caucasians have a higher rate of MS than other ethnic groups. The Multiple Sclerosis Foundation estimates that 350,000 to 500,000 people in the United States have MS, and more than 2.5 million people throughout the world.
MS is considered an autoimmune disease. It is not considered to be hereditary, but there does seem to be a genetic predisposition toward developing MS. Researchers are working to identify factors that may trigger the abnormal immune response. Some suspect viral infections, like Epstein-Barr and Chlamydia. The incidence of MS is higher in places farther from the equator. Vitamin D may be a factor. Other avenues of research include environmental toxins, heavy metals, and other substances. The exact cause of any form of MS remains unknown.
There is no cure for MS. Disease-modifying medications work to reduce the number and severity of relapses and slow the progression of the disease. There are quite a few drugs approved for RRMS. Among them are Avonex, Betaseron, Copaxone, Rebif, and Avonex. These medications are self-injected weekly or daily. A newer medication, Tysabri, is administered intravenously every four weeks. Close monitoring is required. The first oral drugs approved for treating MS are Gilenya, Aubagio, and Tecfidera. People with RRMS have more options than ever. Discuss the potential benefits and side effects of each with your doctor.
Some symptoms of MS can interfere with daily life. Whether or not you choose any of the long-term treatments for RRMS, you may want to address individual symptoms. Over-the-counter medications may ease aches and pains. Your doctor may be able to prescribe medications to treat spasticity, fatigue, and bladder dysfunction. Consult your neurologist to learn what treatments may help improve your quality of life.
If your relapses are particularly severe, your neurologist may recommend a high dose of corticosteroids. These are administered intravenously over the course of several days. Corticosteroids may reduce inflammation and the severity of the relapse, but have no effect on disease progression. Some of the therapies used for MS relapse include Solu-Medrol, Prednisone, Decadron, Acthar Gel, Plasmapheresis, and intravenous immunoglobulin therapy.
Good health depends on maintaining a balanced diet rich in vitamins and nutrients. Exercise can help keep muscles toned and raise energy levels. For people who have a hard time moving, swimming or exercising in the pool can help. Yoga and tai chi can provide low impact exercise while increasing flexibility. These practices can help improve strength, balance, and coordination. Meditation, massage, chiropractic, and acupuncture may ease stress and pain.
RRMS varies a great deal from person to person. It is impossible to offer a prognosis with any degree of certainty. Some people with RRMS experience more frequent and severe relapses. Others remain in remission for years. Some will go on to develop a progressive form of the disease or have permanent disabilities. The good news is that most people with MS do not become permanently disabled and most live a normal or near-normal lifespan.