Content created by Healthline and sponsored by our partners. For more details click here.

This content is created by the Healthline editorial team and is funded by a third party sponsor. The content is objective, medically accurate, and adheres to Healthline's editorial standards and policies. The content is not directed, edited, approved, or otherwise influenced by the advertisers represented on this page, with exception of the potential recommendation of the broad topic area.

Read more about Healthline's advertising and sponsorship policy.

Relapsing-Remitting MS Timeline

Timeline of Relapsing-Remitting Multiple Sclerosis

From initial symptoms and diagnosis to treatments and living with the condition, learn the key points about relapsing-remitting multiple sclerosis (RRMS).

Relapsing-remitting multiple sclerosis (RRMS) is the most common form of multiple sclerosis (MS). MS is a disease of the central nervous system, which includes the brain and spinal cord. The cause of MS is uncertain. It's an autoimmune disease, a type of disease where one's immune system attacks itself rather than fighting off foreign microbes or pathogens.

In MS, the immune system mistakenly attacks the individual's myelin, the protective outer sheath that surrounds nerves. Damage to this insulation can cause affected nerves in the brain or the spinal cord to malfunction. A patient with RRMS experiences symptoms during isolated attacks. These episodes are called "relapses." Eventually, symptoms subside significantly or disappear altogether. This period is called remission. Most patients continue to experience additional relapses and remissions in an unpredictable, sporadic manner.

Advertisement

No two people affected by RRMS will experience the disease the same way. Symptoms vary depending on when an attack occurs and which nerves are affected. Some of the most common symptoms of RRMS include:

Image
Image1
Image2
Image3
Line1
Line2
Line3
Image4
Line4
Image5
Line5
Image6
Line6
Image7
Line7
Image8
Line8
Image9
Image10
Image11
Image12
Image13
Image14
BLURRING OF VISION
PARTIAL TO COMPLETE VISION LOSS
SLURRED SPEECH
"MS HUG"
BOWEL OR BLADDER ISSUES
NUMBNESS OR WEAKNESS
MUSCLE SPASMS
"BRAIN FOG" OR MEMORY ISSUES
DEPRESSION
CONCENTRATION DIFFICULTIES
BALANCE PROBLEMS
FATIGUE
CHRONIC PAIN
SEXUAL DYSFUNCTION
Image BLURRING OF VISION
Image Image
Image "BRAIN FOG"
Image Image
Image VISION LOSS
Image Image
Image DEPRESSION
Image Image
Image SLURRED SPEECH
Image Image
Image NUMBNESS OR WEAKNESS
Image
Image BOWEL ISSUES
Image Image
Image "MS HUG"
Image Image
Image BALANCE PROBLEMS
Image Image
Image CONCENTRATION DIFFICULTIES
Image Image
Image MUSCLE SPASMS
Image Image
Image FATIGUE
Image
Image CHRONIC PAIN
Image
Image SEXUAL DYSFUNCTION
Image Image

Who's at Risk?

Anyone can get RRMS. It's usually diagnosed between 20 and 50 years of age. A majority of people diagnosed with MS receive an initial diagnosis of RRMS. Some people diagnosed with RRMS will develop a more progressive form of the disease.

Up to 85% of new MS diagnoses involve a diagnosis of RRMS.

icon-2

Women are two to three times more likely to be diagnosed than men.

icon-2

Appropriate drug therapy can slow progression of the disease.

Obtaining an initial diagnosis of RRMS can be challenging. Many of the symptoms of an attack resemble effects caused by other illnesses or conditions. A diagnosis of RRMS requires evidence of at least two separate sites within the central nervous system where nerve damage, or lesions, have occurred.

Lesions must have developed at least one month apart. Finally, doctors must rule out other possible explanations for symptoms. MS is not the only disease that involves the destruction of myelin (demyelination).

1 of 5

What Are the Long-Term Prospects for a Patient Diagnosed with RRMS?

Every patient experiences MS differently. Research suggests that the more frequently relapses occur, the more rapid the progression. RRMS progression is marked by constant symptoms and irreversible disability. Early treatment may help slow or halt this progression. As researchers noted recently: "Early is better than late treatment, but late is better than never."

Experts now believe that treating symptoms aggressively early on is the best way to delay or prevent progression of the disease to the primary-progressive form of MS. As noted in the journal Brain, "The prevention or delay of the progressive phase of the disease is implicated as a key therapeutic target in relapsing-remitting patients."

Advertisement

At least a dozen medications have been approved for the treatment of RRMS. These disease-modifying agents are capable of reducing the number of relapses and new lesions. These drugs may also slow disease progression. There's some evidence that earlier treatment leads to better long-term outcomes and less disability. Some drugs must be injected. Others are taken by mouth. Still others must be infused in a clinical setting.

Doctors also often prescribe short courses of potent, anti-inflammatory drugs to manage acute flare-ups or relapses. These may include corticosteroids such as methylprednisolone or prednisone. These drugs are not believed to offer any long-term benefits.

icon-4

Injectable (IM) Medications

Click for more
icon-5

Infusion (IV) Medications

Click for more
icon-3

Oral Medications

Click for more

Treatment Side Effects

Modern drugs have transformed the treatment of MS. Many patients are now able to lead nearly normal lives thanks to targeted therapies that address some of the underlying mechanisms of the disease process. Most drugs focus on inhibiting some aspect of immune system function, so side effects related to the disruption of immune system function are common. Common side effects include:

Please hover over the icon for more information

Image

HEADACHE : People with MS often suffer from headaches, particularly because they're a common side effect of many MS medications, including Tysabri and Gilenya. However, if a headache is persistent, different than a typical headache, or is associated with new neurological symptoms, medical attention should be sought.

NAUSEA : Some oral medications, muscle relaxants, and immunosuppresants used to treat the symptoms of MS can trigger nausea, vomiting, and queasiness. Medications, like steroids, can affect the lining of the stomach, which may also lead to these symptoms. Certain medications can be prescribed to help protect the gut.

FLU-LIKE SYMPTOMS : Disease-modifying drugs for MS are designed to reduce the number of relapses and help with symptoms, but they can also cause flu-like symptoms including chills and fever. It's a common side effect to interferons as well. Often these reactions will dissipate with continued treatment, but other medications, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl), can also be helpful.

DIARRHEA : While less common than constipation, diarrhea is also a frequent symptom for those undergoing MS treatment. It's a listed side effect for Tecfidera, Gileyna, Aubagio, and Lemtrada. Diarrhea generally goes away on its own. But if it persists for more than a couple of days or is associated with fever or bloody stools, medical attention should be sought immediately.

RASH : Rashes and skin irritations are temporary, but they are common side effects of some disease-modifying drugs. It's also listed as a side effect for Avonex, Tysabri, and Tecfidera. Most rashes are transient and benign, but some rare reports of serious skin reactions have been reported. If you experience a painful rash, blister, or ulcer that spreads to the mucosal membranes of your mouth, genitals, or anus, medical attention should be sought immediately.

INFECTIONS : Certain drugs taken for MS can also suppress the immune system, and can make patients more vulnerable to infection, especially those of the urinary tract or upper respiratory tract. Signs of infection may include fever, cough, or pain with urination. Close monitoring is important to find an infection early. Prophylactic antibiotics are sometimes given to help patients manage symptoms.

FEVER : A fever is having a higher-than-normal body temperature (normal is typically 98.6 degrees Fahrenheit). It's a short-term side effect and is often accompanied by other flu-like symptoms, including chills and muscle aches. Once an infection has been ruled out as causing the fever, your doctor may want you to take acetaminophen (Tylenol) or diphenhydramine (Benadryl) to help reduce the fever.

HAIR LOSS : Taking interferons can cause hair thinning or loss. These drugs change the hair's texture, making it more prone to breakage. Hair loss tends to be mild and gradual. Most often, it's reversible and the hair grows back after treatment.

THYROID DYSFUNCTION : Thyroid dysfunction or disease is a known side effect for those taking interferons. The dysfunction usually occurs within the first year of treatment, and results in an underactive thyroid (hypothyrodism). Generally, thyroid dysfunction is reversible and normalizes after the medication is stopped.

HIGH LIVER ENZYME LEVEL : Several MS medications, especially disease-modifying drugs, can affect liver function. High liver enzyme levels can be an indicator of liver damage or disease. This is often a temporary side effect at the beginning of treatment, but it should be monitored closely. The medication should be stopped if liver enzymes don't normalize.

INJECTION SITE REDNES, SWELLING, OR PAIN : There are currently seven injectable medications for MS, all of which can cause temporary injection site reactions including redness, swelling, and pain. Rotating the injection site regularly can help avoid these complications.

LEUKOPENIA : Leukopenia is the medical term used to describe a low white blood cell count. This condition is a rare side effect related to interferon beta treatments, including Avonex, Rebif, Betaseron, and Extavia, and can range in severity. Once identified, the white blood cell count needs to be monitored routinely. You may need to discontinue the medication or therapy if it's severe or persistent.

Image1
Image2
Image3
Line8
Line9
Line10
Image4
Line11
Image5
Line12
Image6
Line13
Image7
Line14
Image8
Line15
Image9
Line16
Line17
Line18
Line19
Image10
Image11
Image12
HEADACHE
FLU-LIKE SYMPTOMS
RASH
DIARRHEA
NAUSEA
LEUKOPENIA
FEVER
HAIR LOSS
THYROID DYSFUNCTION
HIGH LIVER ENZYME LEVEL
INJECTION SITE REDNES, SWELLING, OR PAIN
INFECTIONS
Image HEADACHE

HEADACHE : People with MS often suffer from headaches, particularly because they're a common side effect of many MS medications, including Tysabri and Gilenya. However, if a headache is persistent, different than a typical headache, or is associated with new neurological symptoms, medical attention should be sought.

Image Image
Image FEVER

FEVER : A fever is having a higher-than-normal body temperature (normal is typically 98.6 degrees Fahrenheit). It's a short-term side effect and is often accompanied by other flu-like symptoms, including chills and muscle aches. Once an infection has been ruled out as causing the fever, your doctor may want you to take acetaminophen (Tylenol) or diphenhydramine (Benadryl) to help reduce the fever.

Image Image
Image NAUSEA

NAUSEA : Some oral medications, muscle relaxants, and immunosuppressants used to treat the symptoms of MS can trigger nausea, vomiting, and queasiness. Medications, like steroids, can affect the lining of the stomach, which may also lead to these symptoms. Certain medications can be prescribed to help protect the gut.

Image Image
Image HAIR LOSS

HAIR LOSS : Taking interferons can cause hair thinning or loss. These drugs change the hair's texture, making it more prone to breakage. Hair loss tends to be mild and gradual. Most often, it's reversible and the hair grows back after treatment.

Image Image
Image FLU-LIKE SYMPTOMS

FLU-LIKE SYMPTOMS : Disease-modifying drugs for MS are designed to reduce the number of relapses and help with symptoms, but they can also cause flu-like symptoms including chills and fever. It's a common side effect to interferons as well. Often these reactions will dissipate with continued treatment, but other medications, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl), can also be helpful.

Image Image
Image THYROID DYSFUNCTION

THYROID DYSFUNCTION : Thyroid dysfunction or disease is a known side effect for those taking interferons. The dysfunction usually occurs within the first year of treatment, and results in an underactive thyroid (hypothyrodism). Generally, thyroid dysfunction is reversible and normalizes after the medication is stopped.

Image Image
Image DIARRHEA

DIARRHEA : While less common than constipation, diarrhea is also a frequent symptom for those undergoing MS treatment. It's a listed side effect for Tecfidera, Gileyna, Aubagio, and Lemtrada. Diarrhea generally goes away on its own. But if it persists for more than a couple of days or is associated with fever or bloody stools, medical attention should be sought immediately.

Image Image
Image HIGH LIVER ENZYME LEVEL

HIGH LIVER ENZYME LEVEL : Several MS medications, especially disease-modifying drugs, can affect liver function. High liver enzyme levels can be an indicator of liver damage or disease. This is often a temporary side effect at the beginning of treatment, but it should be monitored closely. The medication should be stopped if liver enzymes don't normalize.

Image Image
Image RASH

RASH : Rashes and skin irritations are temporary, but they are common side effects of some disease-modifying drugs. It's also listed as a side effect for Avonex, Tysabri, and Tecfidera. Most rashes are transient and benign, but some rare reports of serious skin reactions have been reported. If you experience a painful rash, blister, or ulcer that spreads to the mucosal membranes of your mouth, genitals, or anus, medical attention should be sought immediately.

Image Image
Image INJECTION SITE REDNES, SWELLING, OR PAIN

INJECTION SITE REDNES, SWELLING, OR PAIN : There are currently seven injectable medications for MS, all of which can cause temporary injection site reactions including redness, swelling, and pain. Rotating the injection site regularly can help avoid these complications.

Image Image
Image INFECTIONS

INFECTIONS : Certain drugs taken for MS can also suppress the immune system, and can make patients more vulnerable to infection, especially those of the urinary tract or upper respiratory tract. Signs of infection may include fever, cough, or pain with urination. Close monitoring is important to find an infection early. Prophylactic antibiotics are sometimes given to help patients manage symptoms.

Image Image
Image LEUKOPENIA

LEUKOPENIA : Leukopenia is the medical term used to describe a low white blood cell count. This condition is a rare side effect related to interferon beta treatments, including Avonex, Rebif, Betaseron, and Extavia, and can range in severity. Once identified, the white blood cell count needs to be monitored routinely. You may need to discontinue the medication or therapy if it's severe or persistent.

Image Image

A rehabilitation program may be recommended for patients living with RRMS. The goal is to keep or restore abilities that are necessary for daily living. Rehabilitation can help patients get "back on track" after an acute relapse. Depending on a patient's unique situation, any number of clinical specialists may be involved. Services involved may include:

icon-4

Physical therapy

Helps problems ranging from walking and mobility to fatigue and pain.
icon-5

Occupational therapy

Helps patients cope with the demands of the workplace.
icon-3

Language/ speech pathology

Helps address any speech or swallowing issues due to MS.
icon-3

Cognitive therapy

Helps address problems with thinking, reasoning, remembering, and learning due to MS.
Advertisement

A wide variety of medications and therapies may be helpful, at times, to address various symptoms of MS. These treatments don't alter the course of the disease. They merely help alleviate certain symptoms, such as bladder control problems, sexual dysfunction, fatigue, depression, spasticity, bowel dysfunction, tremors, pain, and dizziness.

There's no current cure for MS. Modern drugs may slow the progression of the disease, but eventually most patients will progress towards a form of the disease called secondary-progressive MS (SPMS). At this stage, symptoms usually get worse, and there are few if any periods of remission. Disability increases as the disease progresses.

Experts note that it's crucial for patients to cooperate with their doctors to treat the disease, minimize symptoms, and manage side effects. Experts now think slowing the progression of the disease works best when treatment is started early. Thanks to modern therapies, many people are able to lead normal or near-normal lives through careful monitoring and appropriate treatments and support.

Injectable (IM) Medications

  • Avonex (interferon beta-1a)
  • Betaseron (interferon beta-1b)
  • Copaxone (glatiramer acetate)
  • Extavia (interferon beta-1b)
  • Plegridy (peginterferon beta-1a)
  • Rebif (interferon beta-1a)
  • Glatopa (generic glatiramer acetate)

Infusion (IV) Medications

  • Lemtrada (alemtuzumab)
  • Novantrone (mitoxantrone)
  • Tysabri (natalizumab)

Oral Medications

  • Aubagio (teriflunomide)
  • Gilenya (fingolimod)
  • Tecfidera (dimethyl fumarate)

Physical therapy

Helps problems ranging from walking and mobility to fatigue and pain.

Occupational therapy

Helps patients cope with the demands of the workplace.

Language/speech pathology

Helps address any speech or swallowing issues due to MS.

Cognitive therapy

Helps address problems with thinking, reasoning, remembering, and learning due to MS.

X