By understanding the typical progression of multiple sclerosis (MS) and learning what to expect, you can gain a sense of control and make more informed decisions about your day-to-day life.
MS occurs when the body’s immune system abnormally targets the central nervous system (CNS). The attack on the CNS damages the myelin and the nerve fibers that the myelin protects. The damage disrupts or distorts the nerve impulses being sent down the spinal cord.
People with MS generally follow one of four disease courses that vary in severity.
Clinically isolated syndrome (CIS)
This is the first episode of symptoms caused by inflammation and damage to the myelin covering on nerves in the brain or spinal cord. Technically, CIS doesn’t meet the criteria for a diagnosis of MS, as it’s an isolated incident with only one area of demyelination responsible for symptoms.
If an MRI shows another episode in the past, a diagnosis of MS can be made.
Relapsing-remitting MS (RRMS)
According to the National Multiple Sclerosis Society (NMSS), around 85 percent of people with MS are initially diagnosed with relapsing-remitting MS.
People with RRMS have flare-ups (relapses) of MS. Between the relapses, they have periods of remission. 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. Some of those with the relapsing-remitting form of the condition will go on to develop secondary-progressive MS. This generally happens within 10 years of the first diagnosis.
In secondary-progressive MS, people 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 15 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.
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.
Genetic and environmental factors are thought to play a role in who gets MS. 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 indicate MS.
Common symptoms include:
- numbness and tingling
- walking difficulties
- cognitive changes
- vision problems
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’s no definitive test to confirm the presence of MS, and many of the symptoms also occur with other conditions, so the disease can be tough to diagnose.
In general, MS becomes more severe over time. However, there’s no specific timeline that the condition follows. Everyone with MS will experience their own timeline. Some people with MS won’t notice any progression of symptoms. For others, symptoms may become severe.
Talk to your doctor about your symptoms so that they can come up with a treatment plan specific to you.
The next step on the continuum is receiving a diagnosis of MS.
Your doctor will diagnose you with MS if there’s clear evidence that, at two different points in time, you have had separate episodes of disease activity in your CNS.
Often it can take time to make this diagnosis because other conditions must first be ruled out. These include CNS infections, CNS inflammatory disorders, and genetic disorders.
In the new diagnosis stage, you’ll likely discuss treatment options with your doctor and learn new ways to manage everyday activities with your condition.
Pediatric MS follows a similar course of progression as the adult form of the disease with similar symptoms as well. Also, the disease course may progress more slowly for younger people than it does for adults.
There are a variety of treatment options available to a person 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
While there are not many medications approved by the Food and Drug Administration to treat pediatric MS, medications used to treat adult MS have been studied in children.
Some 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
Other remedies include:
Lifestyle changes include:
- moving more, including stretching
- eating a nutritious 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.
For some people with MS, their condition will never get to the advanced stage. According to the NMSS, about 2 in 3 people with MS will retain the ability to walk throughout their lives.
However, if MS does progress to advanced stages, a person’s quality of life can be impacted. For instance, it may become very difficult to walk, write, or speak.
Although only very rarely fatal, MS can shorten a person’s life by up to 7 years. A caregiver may become needed to help with everyday tasks.
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 having an impact on 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.