Table of ContentsView AllTable of ContentsEarly SymptomsCISRRMSSPMSPPMSFinal StagesFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Early Symptoms
CIS
RRMS
SPMS
PPMS
Final Stages
Frequently Asked Questions
Multiple sclerosis (MS)affects everyone differently, and there is no way to precisely predict how someone’s MS will progress. That said, experts have identified four MS types to help classify and better understand the disease, and also to guide treatment. These types are sometimes referred to as stages because a person’sMS may transition from one type to another.
MS occurs when a person’s immune system attacksmyelin(the fatty sheath that insulates nerve fibers) within their central nervous system (CNS). The CNS is composed of your brain, spinal cord, and theoptic nervesof your eyes.
As ademyelinating disease—which is any condition that develops as a result of myelin damage—the transmission of nerve signals between the CNS and the rest of the body is impaired in MS. This leads to a variety of symptoms like numbness, pain, muscle weakness, and vision problems.
This article will review the four types, or stages, of MS, including how they differ in symptom presentation. You’ll also learn about symptoms that may materialize in the final or advanced stages of MS.
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Early Symptoms of MS
The symptoms of MS vary from person to person, but some symptoms generally occur earlier in the disease course than others.
For example, a classic early manifestation of MS isoptic neuritis, which is inflammation of one of your two optic nerves.This condition causes blurry vision and pain with eye movement.
Other common, early symptoms of MS include:
Clinically Isolated Syndrome (CIS)
CIS is considered amonofocal episodewhen only one neurological symptom is present—for example, an attack of optic neuritis.
CIS is considered amultifocal episodewhen more than one neurological symptom is present—for example, optic neuritis along with paresthesias in the legs that are suggestive of MS.
CIS Doesn’t Always Develop Into MS
Relapsing-Remitting MS (RRMS)
As with CIS, the symptoms of anMS relapsedepend on what nerve signaling pathway in the CNS is being attacked. For instance, if the myelin within the spinal cord is damaged, tingling, numbness, muscle weakness, or bladder problems may occur.
Secondary Progressive MS (SPMS)
Many patients with relapsing-remitting MS (RRMS) transition to a progressive form of the disease called secondary progressive MS (SPMS). This transition signals a shift in disease biology from one of inflammation to one of neurodegeneration, when nerve cells slowly stop working and die.
In SPMS, symptoms are the same as those in RRMS, but they gradually worsen or increase over time. That said, patients with SPMS can still experience occasional relapses and periods of symptom stability. This typical slow shift from relapses to symptom progression can make the diagnosis of SPMS challenging.
RRMS to SPMSOlder studies suggest that patients transition to SPMS around 10–25 years after disease onset. The emergence ofdisease-modifying therapies (DMTs)has likely delayed this transition; although, this has not been fully studied yet.
RRMS to SPMS
Older studies suggest that patients transition to SPMS around 10–25 years after disease onset. The emergence ofdisease-modifying therapies (DMTs)has likely delayed this transition; although, this has not been fully studied yet.
Primary Progressive MS (PPMS)
Around 15% of patients with MS only experience a progressive course from the start of their disease.They are described as havingprimary progressive MS (PPMS)because they experience an accumulation of disability over time.
The biology of PPMS is similar to that of SPMS—more of a smoldering, neurodegenerative process instead of an inflammatory one, which is seen in RRMS. PPMS also strikes at an older age (mid to late 30s on average) compared to RRMS and tends to more aggressively affect the spinal cord.
Spinal cord involvement results in slowly worsening leg stiffness, walking problems, and fatigue. Sexual and bladder and bowel problems may also occur.
Less commonly, PPMS manifests from primary damage to an area of the brain called the cerebellum. This may result intremor(uncontrolled shaking) andataxia(loss of muscle coordination).
While symptoms in the final stages of MS are similar to those in the early stages of MS, they are usually more severe, and there are more of them occurring at the same time.
Such symptoms may include:
Research has also found that the combination of MS with common health conditions likeheart disease,diabetes, or depression increases your chances of dying at a younger age.This finding emphasizes the importance of addressing and managing all of your health needs, in addition to your MS.
How Multiple Sclerosis Affects Life Expectancy
Summary
MS can be classified into four different types, or stages:
CIS is a first-time episode of neurological symptoms and does not technically meet the criteria for a diagnosis of MS. Patients with CIS may or may not go on to develop MS.
A Word From Verywell
Gaining knowledge about the different types of MS may help you or a loved one receive an early diagnosis of MS. Once diagnosed, you can focus your energy on creating a treatment plan with your neurologist that addresses your unique symptoms.
Treatment plans also usually involve taking a disease-modifying medication to slow your disease down and improve your future outlook living with MS.
How Multiple Sclerosis Is Treated
Frequently Asked QuestionsA neurologist uses a variety of tools to diagnose MS, including a medical history, a neurological exam,an MRI, and various blood or spinal fluid tests.Corticosteroids, likeSolumedrol (methylprednisolone)or prednisone, are used to treat moderate or severe MS relapses.Different types of disease-modifying therapies (DMTs) are used to reduce the number of relapses and slow the progression of MS.Other medications and various rehabilitation therapies help patients manage their symptoms and optimize their daily functioning.
A neurologist uses a variety of tools to diagnose MS, including a medical history, a neurological exam,an MRI, and various blood or spinal fluid tests.
Corticosteroids, likeSolumedrol (methylprednisolone)or prednisone, are used to treat moderate or severe MS relapses.Different types of disease-modifying therapies (DMTs) are used to reduce the number of relapses and slow the progression of MS.Other medications and various rehabilitation therapies help patients manage their symptoms and optimize their daily functioning.
Corticosteroids, likeSolumedrol (methylprednisolone)or prednisone, are used to treat moderate or severe MS relapses.
Different types of disease-modifying therapies (DMTs) are used to reduce the number of relapses and slow the progression of MS.
Other medications and various rehabilitation therapies help patients manage their symptoms and optimize their daily functioning.
10 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.
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