What are the stages of multiple sclerosis?
Learning about each type of multiple sclerosis (MS) may help a person gain a better understanding of the disease and its possible treatments following a diagnosis.
MS symptoms occur as a result of the body's immune system mistakenly attacking the nerve fibers and protective myelin sheath around them.
The damage changes the signals that the nerves send to the body and can lead to scarring in the brain and spinal cord.
In this article, learn more about the types and stages of MS, the treatment options, and the outlook for people with this condition.
Stages of MS
MS affects the central nervous system.
MS primarily affects the central nervous system (CNS), which plays a crucial role in many bodily functions.
As MS can affect so many different bodily functions, each person may experience the disease slightly differently.
There are a few different types and stages of MS, which differ in how they progress.
Clinically isolated syndrome (CIS)
CIS is the first episode of MS symptoms that people experience, and it results from inflammation and damage to the myelin sheath. The National MS Society note that doctors will only define the episode as being CIS if it lasts at least a day.
In some cases, a person can experience CIS and not have MS. To diagnose MS, doctors will use magnetic resonance imaging (MRI) to look for active lesions or evidence of past lesions in a person's brain.
In people who go on to receive an MS diagnosis, the early treatment of CIS may help delay the full onset of the disease.
Learn more about the early symptoms of MS.
Relapsing-remitting MS (RRMS)
Most people with MS have relapsing-remitting MS (RRMS). The first signs of the disease will typically appear before the age of 30 years.
A person with RRMS will experience attacks of new or worsening symptoms. After each attack, they will have an extended period in which their symptoms improve or disappear until the next relapse.
In some cases, symptoms become permanent and only get slightly better during remission.
New lesions often appear on the brain after a relapse. However, they may also appear without causing apparent symptoms.
The severity of symptoms can vary depending on the extent and location of the nerve damage. Remission time can range from about a week to many years.
During the remission phase, the disease will show no signs of progression.
Primary progressive MS (PPMS)
Primary progressive MS (PPMS) is less common than RRMS. The National Institute of Neurological Disorders and Stroke state that this type of MS occurs most commonly after the age of 40 years.
People with PPMS have symptoms that gradually get worse over time. They may not have attacks or a sudden onset of symptoms, but they tend to experience symptoms throughout their life without recovery or remission. The severity of these symptoms can vary.
Some treatments for RRMS are less effective in treating the symptoms of PPMS.
Secondary progressive MS (SPMS)
After a person has lived with RRMS for many years, the disease may eventually progress to SPMS.
When this occurs, symptoms will gradually become more severe without any further distinction between attacks and remission.
Doctors may also categorize MS in a few different ways to help people understand how the disease acts in the body. These classifications include:
- Active: A time that includes attacks and new evidence that the disease is progressing.
- Not active: A period during which the person is stable, and there is no apparent evidence that the disease is progressing.
- Worsening: A confirmed and notable increase in the person's disability following a relapse.
- Not worsening: The person experienced a relapse but shows no new or more severe signs of disability.
In advanced or end-stage MS, muscle weakness can lead to a loss of mobility.
In general, MS will follow a trend of becoming more severe or debilitating over time.
People with RRMS may find that their symptoms get worse gradually with each attack. In some cases, they may get better for months or years at a time. In other cases, symptoms may remain after an attack and get worse with time.
After having RRMS, most people will progress into SPMS. The symptoms will get worse over time, and they may stop experiencing relapses or remissions.
In the rare cases when the condition progresses to become advanced or end-stage MS, more severe symptoms occur. Muscle weakness can lead to a loss of mobility, and the person may start to have serious cognitive problems.
A person with advanced or end-stage MS may lose their physical independence and require continuous care.
MS affects each person differently, so the progression of the disease and its symptoms can be unpredictable, even for someone who has had the disease for some time.
The symptoms of MS can include:
- tingling or burning sensations in the body
- vision issues, such as blurred vision or vision loss
- attention and memory issues
- dizziness or vertigo
- trouble walking
- problems with thinking or memory
Less common symptoms may also appear, such as:
In time, secondary symptoms can develop, such as:
- bladder and bowel problems
- difficulty breathing
- muscle weakness
- difficulty swallowing
- sexual health issues
MS can also have an impact on a person's mental and social wellbeing and their ability to work.
Doctors may recommend physical therapy to help manage MS symptoms.
Although there is no cure for MS yet, treatment is always improving.
Treatment for MS typically involves disease-modifying therapy (DMT), which can reduce the numbers of relapses and slow the progression of MS.
- beta interferons (Avonex, Extavia, and others)
- glatiramer (Copaxone)
- siponimod (Mayzent)
- dimethyl fumarate (Tecfidera)
- alemtuzumab (Lemtrada)
As MS and its progression vary between people, a doctor will tailor treatment to meet a person's needs.
Over-the-counter medications, including pain relievers and stool softeners when necessary, may help some people.
Doctors may also order other prescriptions for MS, including corticosteroid injections to relieve inflammation and symptoms during a flare.
In addition, the doctor may offer treatment to relieve specific symptoms, such as:
- muscle spasms
- bladder and bowel problems
Physical therapy can help a person maintain and improve physical strength and the ability to function in everyday life. Occupational therapy can teach an individual new ways to do daily tasks that will better suit their new capabilities. People may also learn how to use assistive devices.
This may help a person if medication is not effective and if they experience severe flares.
It involves removing blood from the body and extracting substances from it that may be harmful. A healthcare professional then returns the "clean" blood to the body.
It may help a person with relapsing forms of MS.
Some complementary therapies may also help some people deal with their symptoms. These include:
Although these practices are not treatments, they may support medical treatment and help some people with MS manage their symptoms.
Regular light exercise may also help keep the body moving. A physical therapist is likely to recommend stretching after light exercise each day to help keep the muscles strong and flexible.
Anyone who is struggling with their symptoms should speak with a doctor to find more effective treatments and support.
Understanding what to expect in each stage of MS can help people get a better idea of how the disease is progressing so they can seek the best treatment.
Treatment involves managing symptoms and slowing down the progression of the disease. Ongoing scientific research aims to find new ways to treat MS.
Additionally, eating a healthful diet, reducing stress levels, and exercising regularly may all help support an MS treatment plan.
By working directly with a doctor, many people can find a treatment plan that makes it easier to manage their symptoms and track the progress of the disease.