If you or a loved one has been diagnosed with multiple sclerosis (MS), you may feel fear or uncertainty. Understanding the typical progression of the disease and learning what to expect can help you gain a sense of control and make better decisions.
The first stage to consider occurs before your doctor has made a diagnosis of MS. In this initial stage, you may have symptoms that you’re concerned about. Perhaps MS runs in your family, and you’re worried about your likelihood of developing the disease. Maybe you’ve previously experienced symptoms that your doctor has told you might be indicative of MS.
At this stage, your doctor can determine whether you’re at high risk for developing the condition based on your medical history and a physical exam. However, there is no definitive test to confirm the presence of MS, so the disease can be tough to diagnose.
The next step on the continuum is receiving a diagnosis of MS. Your doctor will diagnose you with the condition if there is clear evidence that, at two different points in time, you have had two separate episodes of disease activity in your central nervous system (CNS).
This diagnosis can often take time to make because other conditions—such as other CNS infections, CNS inflammatory disorders, and genetic disorders—must first be ruled out. In the new diagnosis stage, you will likely discuss treatment options with your doctor and learn new ways to manage everyday activities with your condition.
The stages of MS generally follow a predictable pattern, beginning with a relapsing form of the illness that later develops into forms that progressively worsen. According to the National Multiple Sclerosis Society (NMSS), around 85 percent of MS sufferers are initially diagnosed with relapsing-remitting MS. In this early stage of the disease, people experience flare-ups of worsening neurologic function. These relapses are followed by recovery periods that are symptom-free.
Relapsing-remitting MS can progress into a more aggressive and progressive form of the disease. The NMSS reports that if left untreated, half of those with the relapsing form of the condition will develop secondary-progressive MS within a decade of the first diagnosis. In secondary-progressive MS, you may still experience relapses followed by partial recoveries, but the disease doesn’t disappear between cycles. Instead, it steadily worsens.
Around 10 percent of people are diagnosed with a relatively uncommon form of the disease, called primary-progressive MS, according to NMSS. This form is characterized by slow and steady disease progression with no remission periods. Some people with primary-progressive MS experience occasional plateaus in their symptoms as well as minor improvements in function that tend to be temporary. There are variations in the progression rate over time.
The most acute form of the condition is called progressive-relapsing MS. This form is the rarest type of MS: only five percent of people receiving this diagnosis at onset of the disease, according to the NMSS. People with progressive-relapsing MS experience a double-whammy of attacks during remission periods and symptoms that steadily get worse.
Although both have cycles of relapses and remissions, this form is different from relapsing-remitting MS. The disease continues to progress during the periods between each relapse.
In addition to adults, children and adolescents can be diagnosed with MS. The NMSS reports that between two percent and five percent of all MS patients noticed symptoms that started before they were 18 years old. Pediatric MS can expect to follow a similar course of progression to the adult form of the disease, with similar symptoms as well. However, some children experience additional symptoms, such as seizures and lethargy. Also, younger patients may find that their disease course progresses more slowly than it does in adults.
When you’re aware of what to look for in each stage of MS, you can take better control of your life and seek appropriate treatments. Researchers continue to make strides in their understanding of the disease. Improved therapeutic advances, new technologies, and FDA-approved medications are impacting the underlying course of MS. Using your knowledge and working closely with your doctor can make MS easier to manage throughout the course of the disease.