Understanding the Four Types of MS
If you’ve just been diagnosed with multiple sclerosis (MS), it can be overwhelming. Learning about the various types you may have, the treatments and the prognosis takes time. Below you’ll find a description of the types of MS, along with a short description of the treatments available.
MS can be categorized into four types, with the name of each type describing how it treats the body. Each type can also be mild, moderate or severe.
Symptoms of MS
Before receiving a diagnosis, you probably noted a laundry list of symptoms that didn’t make a lot of sense. These MS symptoms may have included the following:
- Prolonged double vision and loss of vision (partial or complete); loss of vision typically occurs in one eye at a time
- Tingling or pain throughout the body
- Numbness in the limbs, typically on one side of the body
- Problems with bladder or bowel function
- Slurred speech
- Tremors or unsteady gait
These symptoms can all easily be associated with other serious health conditions; this may be why testing for MS is required to make sure an accurate diagnosis is made.
The Different Types of MS
There are four main types of MS:
- Clinically Isolated Syndrome (CIS)
- Primary-Progressive MS (PPMS)
- Relapsing-Remitting MS (RRMS)
- Secondary-Progressive MS (SPMS)
When reviewing different types of MS, it is important to remember that MS is an unpredictable disease and it varies significantly from person to person. Also, there are other, more rare types of MS, but these primary types provide a fairly comprehensive view of what disease courses MS may take in our lives.
Clinically Isolated Syndrome (CIS)
Though Clinically Isolated Syndrome (CIS) is considered to be the first of the MS types, it differs from MS in that it involves only a first episode (or single incident) of symptoms.
To be diagnosed with CIS, the symptom(s) must be caused by the same process found in MS – inflammation or demyelination in the central nervous system. The symptom(s) also must last for over 24 hours.
The chances of CIS leading to other types of MS varies anywhere from 20% to 80%, depending upon whether brain lesions consistent with MS are found via MRI. If two areas of damage to the central nervous system are found, and they have occurred at different times, or there is an occurrence of a second attack, a diagnosis of MS will most likely follow.
The National MS Society (NMSS) describes CIS as “two to three times more common in women than men. Seventy percent of people diagnosed with CIS are between the ages of 20 and 40 years (average 30 years).”
Primary-Progressive MS (PPMS)
Primary-Progressive MS (PPMS) affects approximately 15% of people with MS. It is characterized by disabilities that begin to accumulate slowly right from its onset. There may be minor remissions, but they seldom occur and are often temporary.
The National MS Society (NMSS) states that PPMS “can be further characterized at different points in time as either active (with an occasional relapse and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapse or new MRI activity) or without progression.”
People with Primary-Progressive MS will have more difficulties with walking and need more assistance with everyday activities. PPMS appears equally in men and women, and the median age of onset is 40 years.
Relapsing-Remitting MS (RRMS)
Relapsing-Remitting MS (RRMS) is the most common form of multiple sclerosis. About 85% of people with MS are initially diagnosed with it. People with RRMS go through unpredictable cycles of exacerbations and remissions where the disease does not progress.
Symptoms depend on the area of the brain or spinal cord that MS has damaged. Symptoms can come and go where others only appear once and never come back. No two people are alike in exacerbation duration, symptom experience, and intensity or the length and level of partiality in remissions.
The Multiple Sclerosis Association of America (MSAA) states “on average, with relapsing forms of MS, women are three times more likely than men to develop this disorder.” The median age of onset of RRMS is 30 years.
Secondary-Progressive MS (SPMS)
40% of Relapsing Remitting MSers transition into Secondary-Progressive MS (SPMS) 15 to 20 years after first being diagnosed. This is a more steadily progressive phase of MS characterized by nerve damage or loss in place of the inflammatory process seen in Relapsing-Remitting MS.
SPMS does not have symptoms that all over the board as in RRMS. SPMS symptoms slowly progress with or without relapses. If relapses do occur, they are usually temporary and do not entirely remit.
As with Primary Progressive MS, National MS Society (NMSS) states that SPMS “can be further characterized at different points in time as either active (with relapses and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapses) or without progression.”
There is a fifth type of MS; this kind of MS exhibits symptoms once but never again. Benign MS occurs in about one-fifth of MS cases.
Treatment for MS
There is no cure or MS. Regardless of the staging of MS, the goal of treatment is to prevent disability, manage symptoms and speed up the recovery process from attacks. There are also quite a few medication options available that may slow progression of MS.
Treatment for Exacerbations
Corticosteroids and plasmapheresis are both used to during an MS flare-up.
- Corticosteroids decrease inflammation. This includes oral prednisone and IV methylprednisolone.
- Plasmapheresis removes the plasma from the blood. The blood is mixed with albumin and transfused back into the body. This is typically done if symptoms are new or not responding to steroids.
Treatments to Slow MS Progression
There are no medical therapies known to slow progression for the PPMS sufferer. RRMS sufferers have a quite a few options:
- Beta interferons are an injection that reduce the frequency and severity of relapses.
- Glatiramer acetate (Copaxone) is an injection that prevents the immune system from attacking the myelin.
- Dimethyl fumarate (Tecfidera) is an oral medication that reduces the amount of relapses.
- Fingolimod (Gilenya) is also an oral medication that reduces the amount of relapses.
Treatments to Manage Symptoms
A large part of MS treatment is managing symptoms.
Physical therapy may help to strengthen and stretch muscles. In addition, the physical therapist may be able to show you how to perform your ADLs easier.
Muscle relaxants can be helpful if you suffer from muscle spasms and muscle stiffness. Other oral medications may be used depending on the type of symptoms noted, such as antidepressants for depression.
Next page: Debra offers her advice on how you can make sense of the different types of MS.