RRMS is characterised by sudden attacks, called relapses, where symptoms worsen, followed by periods of remission where symptoms ease off again.
Take a look at different stages and types of MS associated with RRMS outlined below:
Radiologically isolated syndrome (RIS)
RIS is diagnosed when someone has visible lesions in the brain and spinal cord (also known as the central nervous system or CNS), but does not present with any symptoms. These people are usually identified when they receive a head and neck scan due to other concerns, such as headaches.
RIS is associated with the later development of MS, with about 1 in 3 people with RIS going on to experience at least one attack of symptoms within 5 years of their RIS diagnosis. Although no treatment is required, any lesions that are found should be monitored.
Clinically isolated syndrome (CIS)
CIS refers to a single attack of neurological symptoms that lasts at least 24 hours and can’t be associated with fever, infection or any other illness.
Not everyone who experiences CIS goes on to develop MS.5 While the occurrence of CIS may indicate the onset of RRMS, it might just be an isolated episode.6 The chance of developing MS later down the line depends on whether CIS is accompanied by brain lesions as detected by an MRI scan. There’s an up to 80% chance when brain lesions can be observed alongside CIS, but this probability drops to just 20% without the presence of lesions.
Most cases of CIS don’t require any treatment and symptoms may resolve even before a CIS diagnosis is received.6 However, some people who are identified as high-risk might be prescribed disease-modifying therapies (DMTs), with the aim of delaying MS onset.
Relapsing remitting MS (RRMS)
To receive a confirmed diagnosis of RRMS, you must have experienced an attack of symptoms on at least two separate occasions, supported by MRI results and a history of symptoms.8 It’s the number of confirmed attacks that differentiates CIS from an RRMS diagnosis – a single attack could be an isolated incident, whereas additional attacks indicate that they are relapses characteristic of RRMS disease activity.
If you have been recently diagnosed with RRMS, this is your current stage. As mentioned above, this type of MS can be recognised by periodic cycles of relapse and remission.1-3 The symptoms experienced during a relapse may be new, or existing symptoms may become more severe. Relapses can last anywhere from a few days up to weeks and months, and then remission can make the disease appear inactive for months or years at a time.
Although periods of remission often result in complete physical recovery from relapses through the use of neurological reserve, relapses are associated with a gradual increase in disability over time due to incomplete repair of damage to the brain and spinal cord.
RRMS can be treated with both DMTs that target the underlying cause of the disease, and treatments that can help to ease symptoms.
Secondary progressive MS (SPMS)
Although generally considered a type of MS in its own right, SPMS tends to arise as a second phase of RRMS when neurological reserve is exhausted and can no longer compensate for the damage caused to the brain and spinal cord.
In SPMS, disability progressively worsens over time. However, people may go through periods where their disease stabilises. It’s important to remember that the rate and pattern of progression for each person with SPMS is highly unique.
There is often a period of overlap between RRMS and SPMS when people will still experience relapses despite being considered to have progressed. This is known as relapsing SPMS (rSPMS) and is later followed by progression in the absence of relapses, the more typical presentation of SPMS.
Management options remain the same as people living with RRMS transition to SPMS.