Types of MS
The course of MS is unpredictable. MS symptoms may come and go (relapsing MS or relapsing-remitting) or get steadily worse over time (progressive MS). Some people may have a mild disease course with few restrictions for many years, while others may become severely debilitated relatively quickly. However, most people with MS fall somewhere in between these two extremes [1,2].
Clinically isolated syndrome (CIS)
A CIS refers to a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation or demyelination in the central nervous system (see figure) [1,2].
Relapsing-remitting MS (RRMS)
Approximately 85% of people with MS are initially diagnosed with RRMS, increasingly called relapsing MS (RMS). RRMS is characterized by clearly defined attacks of new or increasing neurologic symptoms. Relapses (also called attacks or exacerbations) are followed by periods of partial or complete recovery (remission). In some cases, symptoms disappear altogether during remission, while in other cases they can persist permanently. There is no apparent disease progression during periods of remission (see figure) [1,2].
Secondary progressive MS (SPMS)
People with relapsing MS may eventually progress to SPMS. It may take years or even decades to transition from RRMS to SPMS. In SPMS there is progressive worsening of symptoms over time with no definite periods of remission (see figure) [1,2].
Primary progressive MS (PPMS)
Approximately 15% of people with MS are diagnosed with PPMS. This form of MS is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms without early relapses or remissions. PPMS can be classified as either “active” or “not active”, as well as either “with progression” or “without progression” [1,2].
The relapsing forms of MS
Prognostic factors suggesting milder or more severe disease course
The presentation of MS at CIS or early in the disease course has been linked to disease course and prognosis.
- MS International Federation. Available at: www.msif.org Return to content
- National Multiple Sclerosis Society. Available at: https://www.nationalmssociety.org Return to content
- Miller D et al. Lancet Neurol 2005; 4(5): 281-188. Return to content
- Langer-Gould A et al. Arch Neurol 2006; 63: 1686-91. Return to content
- Bsteh G et al. PLoS ONE 11(7): e0158978. Return to content
- Tintore M et al. Brain 2015; 138: 1863-74. Return to content
- Popescu V et al. J Neurol Neurosurg Psychiatry 2013; 84: 1082-91. Return to content
- Sintzel MB et al. Neurol Ther 2018; 7(1): 59-85. Return to content