Types of multiple sclerosis

The course of multiple sclerosis is largely unpredictable.

Some people are minimally affected by the disease while in others the impact of the disease is more severe, resulting in swift progress towards disability. Although every person will experience a different combination of symptoms, there are a number of distinct patterns relating to the course of the disease.

Relapsing-remitting multiple sclerosis (RRMS) 

RRMS is the most common disease course characterised by clearly defined attacks or increased neurological activity followed by periods of complete or partial recovery. During periods of remission, all symptoms might disappear, however some might continue or become permanent. There is however no apparent ongoing accumulation of disability. Approximately 85% of people with MS are initially diagnosed with RRMS.

Secondary progressive multiple sclerosis (SPMS) 

SPMS is diagnosed when the condition follows a history of worsening after an original diagnosis of RRMS. To date, there is no clinical test to provide a transition point showing when RRMS changes to SPMS.

In the past, in the absence of treatment, transition to SPMS took about 10 years. 90% of people with RRMS developed SPMS within 20-25 years after diagnosis. With the newer Disease Modifying Therapies available, these figures are changing. SPMS can be further characterised at different points in time as either active (with relapses and/or evidence of new MRI activity) or non-active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapses) or without progression.

Primary progressive multiple sclerosis (PPMS)

PPMS is diagnosed when the condition follows a progressive course from onset, characterised by a worsening of neurological function (accumulation of disability) in the absence of exacerbations prior to clinical progression.  PPMS can have brief periods when the disease is stable, with or without a relapse or new MRI activity, as well as periods when increasing disability occurs with or without new relapses or lesions on MRI.  PPMS can be further characterised at different points in time as either active (with an occasional relapse and/or evidence of new MRI activity) or non-active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapse or new MRI activity) or without progression. 

PPMS involves much less inflammation of the type seen in relapsing MS. As a result, people with PPMS tend to have fewer brain lesions than people with RRMS and more lesions in the spinal cord than in the brain, making PPMS more difficult to diagnose and treat than the relapsing form of MS.

 

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