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MS Stages: What to Expect

Multiple Sclerosis (MS)

Understanding the typical progression of multiple sclerosis (MS) and learning what to expect can help you gain a sense of control and make better decisions.

MS occurs when the body’s immune system abnormally targets the central nervous system, though it is not considered to be an autoimmune disorder. This damages the myelin and the nerve fibers that the myelin protects. This disrupts or distorts the nerve impulses being sent down the spinal cord.

People with MS will generally follow one of four disease courses, varying in severity.

Identifying Symptoms of MS

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. 

Common symptoms include:

  • fatigue
  • numbness and tingling
  • weakness
  • dizziness
  • pain
  • walking difficulties
  • cognitive changes
  • vertigo

Additionally, genetic and environmental factors are thought to play a role in who gets 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.

New Diagnosis

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 must first be ruled out. These include CNS infections, CNS inflammatory disorders, and genetic disorders. 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.

Relapsing-Remitting MS (RRMS)

The stages of MS generally follow a predictable pattern. It begins with a relapsing form of the illness. Later on, it 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.

For those with RRMS, patients will have flare-ups or relapses of MS. In between the relapses, patients will have periods of remission. In most cases, patients will start off with this form of MS. Over a few decades, the course of the disease is likely to change and become more complex.

Secondary-Progressive MS (SPMS)

Relapsing-remitting MS can progress into a more aggressive 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. These are then followed by partial recoveries or periods of remission, but the disease doesn’t disappear between cycles. Instead, it steadily worsens.

Primary-Progressive MS (PPMS)

Approximately 10 percent of people are diagnosed with a relatively uncommon form of the disease, called primary-progressive MS.

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.

Progressive-Relapsing MS (PRMS)

The most acute form of the condition is called progressive-relapsing MS. This form is the rarest type of MS. Only 5 percent of people receive this diagnosis at onset of the disease, according to the NMSS.

People with progressive-relapsing MS experience no 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.

Pediatric MS

In addition to adults, children and adolescents can be diagnosed with MS. The NMSS reports that between 2 and 5 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.

Treatment Options

There are a variety of different treatment options available to patients diagnosed with MS. Your doctor and medical team can help you find the best combination of treatments to manage your symptoms and improve your quality of life.

Over-the-counter treatments include:

  • pain relievers like aspirin or ibuprofen
  • stool softeners and laxatives, for infrequent use

Prescription treatments and medical interventions include:

  • corticosteroids for MS attacks
  • plasma exchanges for MS attacks
  • beta interferons
  • glatiramer (Copaxone)
  • teriflunomide (Aubagio)
  • dimethyl fumarate (Tecfidera)
  • physical therapy
  • muscle relaxants

Alternative remedies include:

  • exercise
  • yoga
  • acupuncture
  • relaxation techniques

Lifestyle changes include:

  • exercising more, including stretching
  • eating a healthier diet
  • reducing stress

Any time you’re making a change to your treatment plan, consult your doctor first. Even natural remedies can interfere with medications or treatments you’re currently taking.

Takeaway

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.

You asked, we answered

  • Are there any ways to slow the progression of MS? If so, what are they?
  • Besides a healthy diet and exercise with stretching, make sure you are taking in enough Vitamin D since MS patients have been found to be deficient. And as always, taking MS medications regularly has been shown to slow the disease progress and prevent relapse. 

    - Mark R. Laflamme, MD
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