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positive living with MS
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Course of the disease
MS is a chronic disease which results in progressive increasing disability in most patients. The course of the disease varies greatly from one patient to another and it is difficult to predict the course of the disease in any given individual.
Four different subtypes of disease have been defined which have broadly different courses of
progression
(ref m2).
Relapsing-Remitting MS (RRMS) Around 80% of people with MS have RRMS. They will experience attacks (relapses) followed by periods of good or complete recovery (remission). The attacks can last from days to weeks or months, some people also find that some of their symptoms can vary from day to day. The number and frequency of relapses and the nature and severity of symptoms experienced are unpredictable.
Secondary Progressive MS (SPMS). Approximately 75% of people initially diagnosed
with RRMS will find that over a period of many years the frequency and severity of relapses will
decrease while disability increases. Some people find that the increase or progression of
disability is very gradual, for others it can occur more quickly.
Primary Progressive MS (PPMS). About 10% of people with MS are diagnosed with this, disability increases from the outset – attacks / relapses are absent. Unlike RRMS and SPMS where there are three women for each man, primary progressive MS is evenly distributed between the sexes. Some people have a steady increase in disability; others may plateaux or have a more gradual worsening of symptoms.
Benign MS People with benign MS have very mild attacks separated by long periods with no symptoms, it can affect up to 10% of people with MS. The long periods with an absence of symptoms mean it can take many years to diagnose. The phrase ‘ benign MS’ can be incorrectly used to describe a period of mild symptoms following diagnosis. Many experts believe that benign MS is probably a very slow mild form of RRMS in which disease activity isn’t obvious.
For a definitive diagnosis of MS, a patient must have evidence of at least two anatomically separate demyelinating events occurring at least 30 days apart (ref m16). However, some patients present with a single event which is suggestive of demyelination, and damage to neurones in the CNS is detectable by MRI scan. Such patients are said to have clinically isolated syndrome (CIS). Many of these patients later develop full MS (ref m17-m18).
Studies have shown that disease-modifying treatments (i.e. interferon beta, glatiramer acetate and natalizumab) can slow the progression of disease for patients with relapsing-remitting MS, and delay onset of secondary progressive MS, as discussed further in Treatments for MS. There is also evidence to suggest that starting treatment in patients diagnosed with CIS rather than full MS decreases the risk of developing full MS. (ref m19-m21) However, no disease-modifying treatments are approved for other subtypes.
Did you know?
Multiple Sclerosis is a disease of unknown origin that affects the central nervous system.
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Page last updated: 22 Jun 2010
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