By understanding the typical progression of 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 your body’s immune system abnormally targets your central nervous system (CNS). The attack on your CNS damages the myelin sheath around nerve fibers and the nerve fibers within. The damage disrupts or distorts the nerve impulses being sent down your 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 damage to the myelin sheath responsible for symptoms.
If an MRI shows another episode in the past, a diagnosis of MS can be given.
Relapsing-remitting MS (RRMS)
According to the National MS Society (NMSS), around 85% of people with MS receive an initial diagnosis of RRMS.
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)
RRMS 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 SPMS. This generally happens within 10 to 25 years of the first diagnosis.
In SPMS, 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 10% to 15% of people receive a diagnosis of a relatively uncommon form of the disease, called PPMS.
This form of MS is characterized by slow and steady disease progression with no remission periods. Some people with PPMS 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 a doctor or healthcare professional gives you 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 a doctor has told you might indicate MS.
Common early symptoms of MS can include:
- numbness and tingling
- walking difficulties
- cognitive changes
- vision problems
At this stage, a doctor can determine whether you’re at high risk of developing the condition based on your medical history and a physical exam.
But 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. But there’s no specific timeline that the condition follows.
Everyone with MS tends to follow their own timeline. Some people with MS won’t notice any progression of symptoms. For others, symptoms may become severe.
Talk with a 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.
A doctor will given you a diagnosis of MS if there’s clear evidence that at two different points in time, you’ve had separate episodes of disease activity in your CNS.
Often it can take time to give 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 a doctor and learn new ways to manage everyday activities with your condition.
In addition to adults, children and adolescents can receive a diagnosis of MS. The NMSS reports that between 3% and 5% of all people with MS noticed symptoms that started before they were 16 years old.
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 who has received a diagnosis of MS. A doctor and medical team can help you find the best combination of treatments to manage your symptoms and improve your quality of life.
Some prescription treatments for MS can include:
- monoclonal antibodies, such as natalizumab (Tysabri)
- beta interferons, such as interferon beta-1a (Avonex) and interferon beta-1b (Betaseron)
- mitoxantrone (Novantrone)
- fingolimod (Gilenya)
- dimethyl fumarate (Tecfidera)
- glatiramer (Copaxone)
- corticosteroids for MS attacks
- plasma exchanges for MS attacks
- teriflunomide (Aubagio)
- muscle relaxants
Practices that may provide relief can include:
Lifestyle changes can include:
- moving more, including stretching
- eating a nutritious diet
- lowering stress
Over-the-counter treatments can include:
- pain relievers, such as aspirin or ibuprofen (Advil)
- stool softeners and laxatives for infrequent use
Any time you’re making a change to your treatment plan, consult with a doctor first. Even natural remedies can interfere with medications or treatments you’re currently using.
Many medications used to treat adult MS have been studied in children and are commonly prescribed for pediatric MS.
Oral fingolimod (Gilenya, Novartis AG) is approved by the Food and Drug Administration (FDA) for pediatric MS in children ages 10 years and older.
For some people with MS, their condition will never get to the advanced stage. According to the NMSS, about two in three people with MS will retain the ability to walk throughout their lives.
But if MS does progress to advanced stages, your quality of life can be impacted. For instance, walking, writing, or speaking may become very difficult.
Although only very rarely fatal, MS can shorten your life by up to 7 years. A caregiver may become needed to help with everyday tasks.
Are there any ways to slow the progression of MS? If so, what are they?
There are many medical treatments that can slow the progression of MS. You should discuss the treatments with your doctor and find one that’s right for you. In addition, leading a healthy lifestyle with proper exercise, diet, and sleep will go a long way toward managing your MS.
Nancy Hammond, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
When you’re aware of what to look for in each stage of MS, you can take better control of your life and get 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 a doctor can make MS easier to manage throughout the course of the disease.