A deep dive into the types and stages of MS
Multiple sclerosis (MS) is an umbrella term that encompasses the many types and stages of MS that exist and that someone living with the condition might have. As well as the different types of MS, the symptoms experienced by people with MS are unique and can also differ from person to person – even between people who are living with the same type of MS. It’s this diversity in disease presentation which makes it so important to avoid comparing your own experiences with MS to those of others.
On the whole, MS can either be relapsing or progressive. However, there is an overlap. Some people may find that their MS is at a stage where they simultaneously experience both relapsing and progressive disease.1,2 The type of MS that someone has will dictate the treatment plan chosen by their neurologist.
Here we are going to explore the different types of MS and the stages of disease that someone might move through as their MS progresses. We will also look at how early action can help to reduce disease progression and improve long-term outcomes for people living with MS.
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.
PPMS is a type of MS that has a progressive disease course from the outset, with a gradual progression of clinical symptoms in the absence of relapses.
As in RRMS and SPMS, the rate of progression in PPMS varies from one person to another. People might experience periods of stability, when their disease stops progressing, between periods of slowly increasing disability.
For someone to be diagnosed with PPMS, they need to have experienced one year of disease progression without remission and at least two of the following: an MS lesion in the brain, two or more lesions of a similar type in the spinal cord, specific evidence in the spinal fluid that indicates immune system activity in the CNS. As it can take time to meet this criteria, it often means that PPMS can take longer to diagnose than other types of MS.
It’s key to act as soon as possible following an MS diagnosis as this has been associated with better long-term outcomes for people living with MS. This is especially important given it can sometimes take a long time for MS to be diagnosed, particularly in the case of PPMS. Potentially damaging disease activity has already happened before receiving a diagnosis, so we must act quickly when symptoms do arise and become noticeable.
Here are some things that you can do to help try and limit the progression of your MS:
If you’re worried about disease progression or notice any changes in your MS, you should talk to your neurologist or MS nurse. Try creating your own Talk To Your Doctor Guide to help you when it comes to having conversations with your healthcare team.