How RRMS progresses

No matter what type of multiple sclerosis (MS) you have, the way in which it progresses can be unpredictable and totally different to somebody else’s experience. In fact, some people living with MS will go on to live with only mild symptoms after their diagnosis, whereas for others, MS may be a rapidly progressive condition. MS has different stages and you may pass through some of them, or all of them.

No matter your experience with MS, be sure to keep an eye on the impact it has on your quality of life and update your neurologist with any changes you notice.

You may go through several key stages living with MS: radiologically isolated syndrome (RIS) where damage shows up on a brain scan but there are no symptoms or clinically isolated syndrome (CIS) where a person has one initial attack of symptoms; relapsing remitting MS (RRMS); secondary progressive MS (SPMS) or primary progressive MS (PPMS). Find out more about the different stages of MS in the section below
If you start your MS treatment within one year of symptom onset, you are less likely to have difficulty sooner than people who start treatment three years after onset of symptoms
Damage can be taking place to the brain in the early stages of MS that might not cause noticeable symptoms – this happens as a result of something called brain reserve
Over time, damage to the central nervous system (CNS) can build up, causing symptoms and worsening disability

Of course, everybody is different. But here are the key stages and types of MS you may progress through with RRMS:

The type of MS you have can affect how often you experience symptoms as well as when and how disability develops. It can also impact the options you have for managing your MS.

Radiologically isolated syndrome (RIS): At this stage, there are changes in your brain that may look like MS, but no noticeable symptoms to indicate a problem

Clinically isolated syndrome (CIS): You’ve had one isolated attack of symptoms that may appear to be due to MS, but you can’t yet be diagnosed with MS

Relapsing remitting MS (RRMS): The majority of people living with MS (about 85%) are diagnosed with RRMS. RRMS is characterised by relapses (periods of worsening symptoms) followed by remissions (extended periods of good or complete recovery). You might hear your doctor or MS nurse mention something called the McDonald criteria, which can help them to make a diagnosis after only one relapse if they have enough information from your MRI scans.

Symptoms may initially be reversible, but they can become permanent as the disease progresses. Over time, damage can build up and become too difficult for the brain to repair. This can lead to permanent symptoms. RRMS can progress to SPMS, especially if it’s left untreated.

Secondary progressive MS (SPMS): Without the right treatment, 50—60% of people living with RRMS will go on to develop SPMS within 15—20 years after their MS diagnosis. SPMS is characterised by a progressive decline in function and increase in disability – with or without periods of relapse and remission. However, the rate at which this happens can vary a great deal from one person to another.

Primary progressive MS (PPMS): A form of MS in which disability increases from the beginning of their MS disease. About 10% of people living with MS are diagnosed with this type.

The experience you may have living with PPMS may vary significantly from other people with PPMS. People generally experience a continuous increase in disability, but this can happen at different rates. Some may experience a more gradual worsening of symptoms, while others may find that their symptoms stop worsening for long periods of time.

It can be good to understand what’s going on in the brain in the early stages of MS, especially when you’re working with your doctor or MS nurse to choose how to best manage your MS.

Early on in the condition, the brain may find ways to partially compensate for damaged nerve cells by using other pathways to send signals from the damaged parts of the brain to undamaged regions. In doing so, messages can be restored between your brain and the rest of your body. The brain also attempts to cope with nerve cell loss by repairing myelin, a process known as remyelination.8 However, because these repair mechanisms can mask symptoms, some people living with MS may go undiagnosed and untreated in the early stages.

Everyone’s brain very gradually starts to shrink as they get older. This is sometimes called brain atrophy or brain volume loss (BVL). It’s a normal part of aging, but it can happen a little faster when you’re living with MS.

Initially, your body tries to repair the protective myelin coating which gets damaged in MS. However, the body’s repair process is far from perfect and as time goes on, it’s not enough to prevent further damage to the nerve cells. As damage continues, your brain can no longer use other pathways to compensate for nerve loss as areas of damage become too large.1 It’s this that may result in brain atrophy.

As MS progresses, parts of your central nervous system (CNS) can start to become permanently blocked. It’s at this point that disability can continue to worsen over time, with or without relapses, and you enter secondary progressive MS (SPMS)

Interested in more? Discover how you can best manage your MS to continue living your life as you want to.

Multiple sclerosis by the numbers: facts, statistics and you. Available at: http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic. Last accessed: October 2017.
Giovanni G et al. 2017. Brain health: time matters in multiple sclerosis. Available at: https://www.msbrainhealth.org/report. Last accessed: October 2017.
Kavaliunas A et al. Mult Scler Journal 2017; 23 (9) 1233-1240.
Scolding N et al. Pract Neurol 2015;15:273–279.
Relapsing remitting MS. Available at: https://www.mstrust.org.uk/a-z/relapsing-remitting-ms-0. Last accessed: October 2017.
McDonald criteria. Available at: https://www.mstrust.org.uk/a-z/mcdonald-criteria. Last accessed: December 2019.
Types of MS. Available at: https://www.mstrust.org.uk/a-z/types-ms. Last accessed: October 2017.
What is myelin? Available at: https://www.nationalmssociety.org/What-is-MS/Definition-of-MS/Myelin. Last accessed: October 2017.

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