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 (CNS), though it’s not considered to be an autoimmune disorder. 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.

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 be indicative of MS.

Common symptoms include:

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 and many of the symptoms also occur with other conditions, 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 MS if there is 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 will likely discuss treatment options with your doctor and learn new ways to manage everyday activities with your condition.

There are different types and stages of MS. Learn more below about the different types.

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.

The relapsing-remitting type of MS generally follows a predictable pattern with periods in which symptoms worsen and then improve. Eventually it may progress to secondary-progressive MS.

According to the National Multiple Sclerosis Society (NMSS), around 85 percent of MS sufferers 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.

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-remitting form of the condition 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.

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.

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 follows a similar course of progression as the adult form of the disease with similar symptoms as well. However, some children experience additional symptoms, such as seizures and lethargy. 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

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:

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.

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.

Q:

Are there any ways to slow the progression of MS? If so, what are they?

A:

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, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.