Types of Multiple Sclerosis
For many years, neurologists have categorized MS into distinct types: relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS). The types of MS are usually defined by the different symptom patterns that emerge as your MS progresses.
The latest research shows that these types of MS aren’t actually all that different. The underlying disease process is similar regardless of the type of MS you have. All types of MS progress from the start – even if you don’t experience symptoms and regardless of your symptom pattern.
Continue reading to find out more about the different types of MS and learn how they’re not actually all that different…
So, why is it still important to know which type of MS you have? Knowing which type of MS you have helps your healthcare team to assess how your disease is developing and to predict how it might affect you in the future, and will determine the treatment options available to you. Diagnosis can be challenging as MS follows an unpredictable disease course, symptoms can come and go over many years, and the symptoms experienced are different for everyone.
The three main types of MS (RRMS, PPMS, or SPMS) are categorized according to how quickly symptoms appear and how they change over time. The symptoms you experience depend on which areas of your central nervous system are affected.
RRMS is the most common form of MS. In fact, up to 80–90% of people living with MS are first diagnosed with RRMS. This type of MS is defined by symptoms that come and go, with relapses that can happen quickly and then level off over the following weeks or months, in a period called remission.
You may find yourself making a good or full recovery after a symptom relapse, or symptoms may persist between relapses. This can lead to the steady progression of your MS as disability accumulates.
Does RRMS always progress?
All types of MS, even RRMS, are known to progress from the start, even if you don’t notice symptoms. There are treatments available to help you. Talk to your neurologist about available treatment options that might be suited to you.
The graph below shows that RRMS is associated with periods of relapses (sudden symptom worsening) and remission (symptom recovery) (pink line). Underlying disease progression continues from the start, even when you are not experiencing symptoms.*
Around 90% of people diagnosed with RRMS go on to develop SPMS within 25 years. Signs of SPMS developing include a gradual worsening disability and more noticeable symptoms between relapses.
Because it can be difficult to identify the precise change from RRMS to SPMS, a diagnosis of SPMS requires careful monitoring of changes to your symptoms, follow-up neurological exams, and looking at magnetic resonance imaging (MRI) scans over time.
Can SPMS improve?
During the initial stages of SPMS, your symptoms might improve after a relapse, but the underlying disease progression still continues in the background. As time goes on, symptoms will become more noticeable in between relapses, until there are no distinct relapses and symptoms continuously get worse. The damage to nerves caused by MS cannot be reversed, but, with disease management in the early stage of RRMS, you can help slow down the physical disability, and there are other treatments available too.
The graph below shows the typical transition from RRMS to SPMS over time. There is a gradual worsening of symptoms in between relapses to a point at which there are no noticeable relapses (green line). Underlying disease progression continues from the start, even when you are not experiencing symptoms.*
Diagnosed in only about 10–15% of people with MS, PPMS often appears in people after their 40s and affects men and women equally.
People with this type of MS do not experience a clear relapse and remission pattern. Instead, they notice a gradual worsening of symptoms that first appear as subtle and gradually become more noticeable over time. The symptoms may stabilize for a period of time and patients can experience occasional relapses. Because of this, it can take time to diagnose PPMS. Keeping track of all your symptoms helps ensure your healthcare team is able to make the earliest diagnosis possible, provide the right treatment for you.
The graph below shows that PPMS is associated with a gradual worsening of symptoms over time (aqua line) with periods of stability and occasional relapses. Underlying disease progression continues from the start, even when you are not experiencing symptoms.*