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Table of Contents
How Is MS Diagnosed?
Types of MS
Other Types of MS
Facts About MS Progression
Frequently Asked Questions
Multiple sclerosis(MS) is an unpredictable disease that comes in several distinct forms. The four main types of multiple sclerosis are clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). Other classifications exist as well for rarer forms of the disease.
This article will look at how MS is diagnosed, expand on the different types and how each one progresses, and explain what the outlook is like for the different types of MS.
Verywell / Laura Porter
MS isdifficult to diagnose. Each case involves a unique set of symptoms that may be similar to a host of other illnesses.
It is anautoimmune disease. The immune system mistakesmyelin, a coating on the nerves, for a dangerous invader, like a virus. It then attacks and tries to destroy it. The attack leads to damage—calleddemyelination—and inflammation in the central nervous system (CNS, brain and spinal nerves), which leads to lesions. Lesions cause MS symptoms.
They’re also part of the diagnostic process. Under guidelines called the McDonald criteria, MS is diagnosed if a patient has:
To determine if patients meet the criteria, healthcare providers use:
A doctor may also order blood work, imaging, and other tests, depending on specific symptoms, to rule out other conditions.
RecapMS is an autoimmune condition that’s hard to diagnose. Healthcare providers use neurological exams, nerve testing, an MRI, a lumbar puncture, andother toolsto reach a diagnosis.
Recap
MS is an autoimmune condition that’s hard to diagnose. Healthcare providers use neurological exams, nerve testing, an MRI, a lumbar puncture, andother toolsto reach a diagnosis.
Based on new knowledge from research, the definitions were updated in 2013. The diagnostic criteria continue to be refined as well. The most recent update was in 2017.
Clinically Isolated Syndrome
Clinically isolated syndrome is somewhat of a “pre-MS” diagnosis. CIS is diagnosed if patients have:
Some people with CIS never have another attack. If an MRI doesn’t find a lesion, a patient has a low likelihood of developing MS. However, if an MRI does detect an MS-like lesion, a patient is very likely to eventually have more episodes and be diagnosed with relapsing-remitting MS.
The 2017 diagnostic guidelines update allows CIS to be diagnosed as MS if there’s evidence of prior lesions, which may not have caused symptoms. This allows for earlier diagnosis and treatment, which may delay the onset of full-blown MS.
In-Depth: Clinically Isolated Syndrome
Relapsing-Remitting MS
Relapsing-remitting MS is the most common type. About 80%–85% of MS cases are initially diagnosed as RRMS.
Symptoms may all disappear during remissions, or some may continue while others recede. The disease doesn’t have any apparent worsening during remissions.
In-Depth: Relapsing-Remitting MS
Secondary Progressive MS
Some people with RRMS will eventually transition to this more severe type. Secondary progressive MS gets progressively worse, regardless of remissions.
Some people with SPMS continue to have relapses and remissions, but not all do. And the remissions tend to include more symptoms than in RRMS.
If RRMS isn’t treated, about 50% of the time it’ll progress to SPMS within a decade.
In-Depth: Secondary Progressive MS
Primary Progressive MS
PPMSinvolves steadily worsening disease and two additional criteria from the following:
PPMS generally involves more spinal cord lesions and fewer brain lesions than RRMS.
Compared with White people, Black people with MS appear to have a more severe disease course and lab results that reveal a worse prognosis. Health disparities for other conditions have been linked to systemic racism in healthcare that harms Black patient health.Researchers have called for further investigation into MS health disparities to help guide treatment and meet the specific needs Black patients may have.
Some forms of MS are rare, and some are even controversial. They include:
RecapCIS is often a pre-MS diagnosis. It can be diagnosed after just one episode. RRMS is the most common type and includes symptoms that come and go. It sometimes transitions to SPMS, which is steadily more disabling and may include milder relapses. PPMS is steadily disabling from the beginning. Other types of MS are rare or controversial.
CIS is often a pre-MS diagnosis. It can be diagnosed after just one episode. RRMS is the most common type and includes symptoms that come and go. It sometimes transitions to SPMS, which is steadily more disabling and may include milder relapses. PPMS is steadily disabling from the beginning. Other types of MS are rare or controversial.
MS is an unpredictable disease. No one can say for sure how severe one’s symptoms will become orhow quickly the disease will progress.
As MS progresses, healthcare providers may talk about where a patient falls on theExpanded Disability Status Scale(EDSS). The EDSS goes from 0 to 10 in 0.5-unit increments. Higher numbers mean greater disability. A score of 10 means the person died from MS.
The EDSS evaluates patients based on MS-related impairment in eight functional systems. Each functional system is a network of neurons in the brain that’s associated with certain tasks.
The functional systems include:
With modern diagnostics and treatments, most people never reach the higher scores. In one large study, 51% of people scored 5 or lower, and 88% had a score of 7 or lower.
To put that in perspective:
Only 12% of people with MS progress beyond this to the point of needing to be pushed in a wheelchair; being confined to bed; being totally dependent on others for care; or dying from MS.Advancements in treatments and diagnostics will likely keep more people out of the higher numbers in the future.
RecapThe progression of MS is unpredictable. The Expanded Disability Status Scale is used to rate levels of disability. Thanks to modern treatments, most people never reach the highest levels.
The progression of MS is unpredictable. The Expanded Disability Status Scale is used to rate levels of disability. Thanks to modern treatments, most people never reach the highest levels.
If a patient has CIS, one of three things can happen:
A 2018 study using a model to simulate the course of CIS looked at rates of transition from one stage to the next in 10-year increments. At 10 years post-CIS diagnosis:
At 50 years post-CIS diagnosis:
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RRMS is most often diagnosed in people between 20 and 40 years old. The transition to SPMS generally happens at least 10 years after diagnosis.
The most common symptoms of RRMS include:
RRMS is less likely than progressive forms to cause problems with walking.
According to a 2017 study, thelife expectancyof someone with RRMS is between six and seven years shorter than that of the general population.However, that number may shrink due to newer treatments and improved diagnostics.
About 50% of people diagnosed with RRMS transitioned to SPMS in the first 10 years. That number jumped to 90% in 25 years. Many experts believe newer medications will help lower those numbers, but it’s too soon to tell.
More than two-thirds of people with SPMS retain the ability to walk. But some may need an assistive device like a cane or walker.
Recent studies haven’t looked at the life expectancy for people with SPMS. Most sources estimate it at between seven and 14 years less than the general population.
Symptoms of PPMS tend to be associated with movement more often than the other types. This is because of progressive degeneration of the spinal cord, also called progressive myelopathy.
That can cause:
The 2017 study estimated that life expectancy for someone with PPMS is about six years less than for someone with RRMS and about 13 years less than the general population. Again, newer drugs may significantly change this number in the future.
Factors Affecting Prognosis
Factors that can suggest someone may have a faster disease progression include:
RecapPatient outlook depends on what type of MS they have. Most cases of CIS eventually progress to RRMS and possibly SPMS. RRMS generally transitions to SPMS after at least a decade. About two-thirds of people with SPMS retain the ability to walk, some with mobility aids. PPMS involves more spinal cord degeneration and movement problems.
Patient outlook depends on what type of MS they have. Most cases of CIS eventually progress to RRMS and possibly SPMS. RRMS generally transitions to SPMS after at least a decade. About two-thirds of people with SPMS retain the ability to walk, some with mobility aids. PPMS involves more spinal cord degeneration and movement problems.
Summary
The four main types of MS are clinically isolated syndrome, relapsing-remitting MS, secondary progressive MS, and primary progressive MS. Diagnosis requires two lesions of different ages and in different parts of the central nervous system and ruling out other possible causes of symptoms.
Progression depends on type and many other factors. It’s measured with the Expanded Disability Status Scale. Most people never get beyond a 7 on this 0–10 scale. Patient outlook also depends on type, age of onset, early symptoms and severities, and the number of brain lesions at diagnosis.
A Word From Verywell
No two cases of MS are alike, but certain commonalities exist that help guide healthcare providers when it comes to treatment decisions.
Once a patient has a diagnosis and knows which type of MS they have, it’s time to start looking at treatment options. Many more are available now compared to just a few years ago, so the outlook for people with this condition is improving all the time.
Frequently Asked QuestionsFulminate MS is the name given to the most aggressive cases of multiple sclerosis. It’s also called malignant or Marburg MS. This type progresses rapidly and involves severe relapses in the first five years after diagnosis. However, all forms of MS have varying degrees of severity. The mildest form is benign MS.The progression of MS is typically monitored with MRI scans of the brain and spinal cord. They allow for a healthcare provider to determine:The number and type of lesions a patient hasThe presence or extent of nerve damageWhether a patient is responding to treatmentDepending on how active and progressive the disease is, patients may have them as often as every six months or only about every two years. Healthcare providers also use the Expanded Disability Status Scale and neurologic exams to track MS progression.The short answer is yes. The disease sometimes goes unrecognized for years.One of a few things could be going on in that situation, including:People could have benign MS or a mild case of another form and don’t yet realize it.People could be misdiagnosed with something else when it’s actually MS.People could have radiologically isolated syndrome (RIS), which means they have evidence of MS-like lesions but have never had symptoms.MS treatment isn’t necessarily the same at every stage. Generally, for CIS and RRMS, disease-modifying therapy (DMT) is started as early as possible. They’re most effective early on in the disease.However, if a patient progresses to SPMS, these treatments may no longer work for them.A doctor may switch them to a newer DMT that’s approved for SPMS.
Fulminate MS is the name given to the most aggressive cases of multiple sclerosis. It’s also called malignant or Marburg MS. This type progresses rapidly and involves severe relapses in the first five years after diagnosis. However, all forms of MS have varying degrees of severity. The mildest form is benign MS.
The progression of MS is typically monitored with MRI scans of the brain and spinal cord. They allow for a healthcare provider to determine:The number and type of lesions a patient hasThe presence or extent of nerve damageWhether a patient is responding to treatmentDepending on how active and progressive the disease is, patients may have them as often as every six months or only about every two years. Healthcare providers also use the Expanded Disability Status Scale and neurologic exams to track MS progression.
The progression of MS is typically monitored with MRI scans of the brain and spinal cord. They allow for a healthcare provider to determine:
Depending on how active and progressive the disease is, patients may have them as often as every six months or only about every two years. Healthcare providers also use the Expanded Disability Status Scale and neurologic exams to track MS progression.
The short answer is yes. The disease sometimes goes unrecognized for years.One of a few things could be going on in that situation, including:People could have benign MS or a mild case of another form and don’t yet realize it.People could be misdiagnosed with something else when it’s actually MS.People could have radiologically isolated syndrome (RIS), which means they have evidence of MS-like lesions but have never had symptoms.
The short answer is yes. The disease sometimes goes unrecognized for years.
One of a few things could be going on in that situation, including:
MS treatment isn’t necessarily the same at every stage. Generally, for CIS and RRMS, disease-modifying therapy (DMT) is started as early as possible. They’re most effective early on in the disease.However, if a patient progresses to SPMS, these treatments may no longer work for them.A doctor may switch them to a newer DMT that’s approved for SPMS.
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22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Multiple Sclerosis Society.Diagnosing MS.University of Michigan Health System.Neurological examination for multiple sclerosis.Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319. doi:10.1177/1352458517707265Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-XMedlinePlus.CSF oligoclonal banding.Multiple Sclerosis Association of America.Types of multiple sclerosis.Multiple Sclerosis News Today.Types of MS.Berger JT, Miller DR. Health Disparities, Systemic Racism, and Failures of Cultural Competence.Am J Bioeth. 2021;21(9):4-10. doi:10.1080/15265161.2021.1915411Cipriani VP, Klein S.Clinical characteristics of multiple sclerosis in African-Americans.Curr Neurol Neurosci Rep. 2019;19(11):87. doi:10.1007/s11910-019-1000-5Lebrun-Frenay C, Kantarci O, Siva A, et al.Radiologically isolated syndrome: 10-year risk estimate of a clinical event.Ann Neurol. 2020;88(2):407-417. doi:10.1002/ana.25799Şen S.Neurostatus and EDSS calculation with cases.Noro Psikiyatr Ars. 2018;55(Suppl 1):S80-S83. doi:10.29399/npa.23412Multiple Sclerosis Trust.Expanded disability status scale (EDSS).National Multiple Sclerosis Society.Kurtzke Expanded Disability Status Scale (EDSS).Hou Y, Jia Y, Hou J.Natural course of clinically isolated syndrome: a longitudinal analysis using a Markov model.Sci Rep. 2018;8(1):10857. doi:10.1038/s41598-018-29206-yLunde HMB, Assmus J, Myhr KM, Bø L, Grytten N.Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study.J Neurol Neurosurg Psychiatry. 2017;88(8):621-625. doi:10.1136/jnnp-2016-315238Multiple Sclerosis Trust.Life expectancy.National Multiple Sclerosis Society.Secondary progressive MS (SPMS).National Multiple Sclerosis Society.Frequently asked questions about SPMS.Multiple Sclerosis News Today.Multiple sclerosis prognosis and life expectancy.Multiple Sclerosis Association of America.Understanding progression in MS.Augusta University Health.Undiagnosed multiple sclerosis is more common than you think.Gajofatto A, Benedetti MD.Treatment strategies for multiple sclerosis: When to start, when to change, when to stop?.World J Clin Cases. 2015;3(7):545-555. doi:10.12998/wjcc.v3.i7.545Additional ReadingNational Multiple Sclerosis Society.Types of MS.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Multiple Sclerosis Society.Diagnosing MS.University of Michigan Health System.Neurological examination for multiple sclerosis.Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319. doi:10.1177/1352458517707265Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-XMedlinePlus.CSF oligoclonal banding.Multiple Sclerosis Association of America.Types of multiple sclerosis.Multiple Sclerosis News Today.Types of MS.Berger JT, Miller DR. Health Disparities, Systemic Racism, and Failures of Cultural Competence.Am J Bioeth. 2021;21(9):4-10. doi:10.1080/15265161.2021.1915411Cipriani VP, Klein S.Clinical characteristics of multiple sclerosis in African-Americans.Curr Neurol Neurosci Rep. 2019;19(11):87. doi:10.1007/s11910-019-1000-5Lebrun-Frenay C, Kantarci O, Siva A, et al.Radiologically isolated syndrome: 10-year risk estimate of a clinical event.Ann Neurol. 2020;88(2):407-417. doi:10.1002/ana.25799Şen S.Neurostatus and EDSS calculation with cases.Noro Psikiyatr Ars. 2018;55(Suppl 1):S80-S83. doi:10.29399/npa.23412Multiple Sclerosis Trust.Expanded disability status scale (EDSS).National Multiple Sclerosis Society.Kurtzke Expanded Disability Status Scale (EDSS).Hou Y, Jia Y, Hou J.Natural course of clinically isolated syndrome: a longitudinal analysis using a Markov model.Sci Rep. 2018;8(1):10857. doi:10.1038/s41598-018-29206-yLunde HMB, Assmus J, Myhr KM, Bø L, Grytten N.Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study.J Neurol Neurosurg Psychiatry. 2017;88(8):621-625. doi:10.1136/jnnp-2016-315238Multiple Sclerosis Trust.Life expectancy.National Multiple Sclerosis Society.Secondary progressive MS (SPMS).National Multiple Sclerosis Society.Frequently asked questions about SPMS.Multiple Sclerosis News Today.Multiple sclerosis prognosis and life expectancy.Multiple Sclerosis Association of America.Understanding progression in MS.Augusta University Health.Undiagnosed multiple sclerosis is more common than you think.Gajofatto A, Benedetti MD.Treatment strategies for multiple sclerosis: When to start, when to change, when to stop?.World J Clin Cases. 2015;3(7):545-555. doi:10.12998/wjcc.v3.i7.545
National Multiple Sclerosis Society.Diagnosing MS.
University of Michigan Health System.Neurological examination for multiple sclerosis.
Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319. doi:10.1177/1352458517707265
Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-X
MedlinePlus.CSF oligoclonal banding.
Multiple Sclerosis Association of America.Types of multiple sclerosis.
Multiple Sclerosis News Today.Types of MS.
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Cipriani VP, Klein S.Clinical characteristics of multiple sclerosis in African-Americans.Curr Neurol Neurosci Rep. 2019;19(11):87. doi:10.1007/s11910-019-1000-5
Lebrun-Frenay C, Kantarci O, Siva A, et al.Radiologically isolated syndrome: 10-year risk estimate of a clinical event.Ann Neurol. 2020;88(2):407-417. doi:10.1002/ana.25799
Şen S.Neurostatus and EDSS calculation with cases.Noro Psikiyatr Ars. 2018;55(Suppl 1):S80-S83. doi:10.29399/npa.23412
Multiple Sclerosis Trust.Expanded disability status scale (EDSS).
National Multiple Sclerosis Society.Kurtzke Expanded Disability Status Scale (EDSS).
Hou Y, Jia Y, Hou J.Natural course of clinically isolated syndrome: a longitudinal analysis using a Markov model.Sci Rep. 2018;8(1):10857. doi:10.1038/s41598-018-29206-y
Lunde HMB, Assmus J, Myhr KM, Bø L, Grytten N.Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study.J Neurol Neurosurg Psychiatry. 2017;88(8):621-625. doi:10.1136/jnnp-2016-315238
Multiple Sclerosis Trust.Life expectancy.
National Multiple Sclerosis Society.Secondary progressive MS (SPMS).
National Multiple Sclerosis Society.Frequently asked questions about SPMS.
Multiple Sclerosis News Today.Multiple sclerosis prognosis and life expectancy.
Multiple Sclerosis Association of America.Understanding progression in MS.
Augusta University Health.Undiagnosed multiple sclerosis is more common than you think.
Gajofatto A, Benedetti MD.Treatment strategies for multiple sclerosis: When to start, when to change, when to stop?.World J Clin Cases. 2015;3(7):545-555. doi:10.12998/wjcc.v3.i7.545
National Multiple Sclerosis Society.Types of MS.
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