Benign multiple sclerosis (MS) describes a form of MS that a person may have for several years without experiencing any of the severe symptoms that the condition generally causes.
MS is a chronic inflammatory, demyelinating, neurodegenerative disease. It can be unpredictable and tends to affect people in different ways. MS attacks a substance called myelin, which surrounds nerve fibers in the central nervous system (CNS). This activity causes inflammation and damages nerve cells.
Over time, scar tissue develops, forming lesions that interfere with the CNS’s ability to communicate with the body. The location of the lesions can affect which symptoms occur, but it is not generally possible to predict the course of MS.
Keep reading to learn more about benign MS, including the symptoms and the treatment and management of the condition.
Definitions of benign MS vary, with some
People sometimes describe benign MS as a version of the most common type of MS, which is relapsing-remitting MS. The hallmark of relapsing-remitting MS is alternating periods of relapse and remission. A relapse refers to a flare-up of symptoms, whereas symptoms are minimal or absent during remission. Benign MS may simply represent a long period of remission in which few or no symptoms are present.
Neurologists may use a scale called the Expanded Disability Status Scale (EDSS) to recognize benign MS. The EDSS measures the extent of physical impairment
According to studies, up to 10% of people with MS have a benign disease course, meaning that they experience no relapses and have a mild, stable form of disability that develops over time.
Generally speaking, doctors will only describe a person as having benign MS if they have lived 15 years without experiencing many MS-related symptoms and have little to no disability from the disease.
If a person has benign MS, it does not necessarily mean that they will be completely without symptoms. An MRI scan may still show signs of damage to the brain and spinal cord.
A person with benign MS may still experience some symptoms, including:
- cognitive issues, such as memory loss and the inability to concentrate
- problems with vision
- tingling and numbness
- muscle spasms
For a neurologist to diagnose a person with benign MS, the standard criterion is a score of below three on the EDSS, which means that the person may live with some disability but is still able to walk.
People with MS can only receive this diagnosis 15 or more years after the initial diagnosis of MS.
There is no cure for MS, but it is treatable. The EDSS score a person receives can determine their treatment options.
Many of the current medications for MS can have serious side effects, and some carry significant risks. For this reason, doctors may advise a person with benign MS to defer treatment unless their health is significantly affecting their quality of life.
If a person does receive treatment for MS, this will focus on minimizing flare-ups and delaying disease progression.
A doctor may prescribe medications to treat MS symptoms when flare-ups occur.
A doctor may give corticosteroids intravenously and prescribe a follow-up course of oral corticosteroids. An example of these drugs is methylprednisolone (Medrol). Medications may hasten a person’s recovery from MS attacks, but they do not alter the long-term outcome of the disease.
Plasma exchange (plasmapheresis)
Plasmapheresis involves a doctor taking blood from the person’s body and separating the components to remove the plasma. The doctor then transfuses the rest of the blood, alongside replacement plasma, back into the body.
A doctor may prescribe injectable, infusion, or oral therapies. They may recommend a combination of two of these or all three.
These include beta interferon drugs and glatiramer acetate (Copaxone).
Doctors commonly prescribe beta interferon drugs for the treatment of MS. These drugs affect interferons, which are signaling molecules that regulate immune cells.
Glatiramer acetate changes the balance of the immune cells in the body, although experts are not entirely sure how it works.
These include natalizumab (Tysabri) and ocrelizumab (Ocrevus).
A doctor will administer natalizumab intravenously on a monthly basis. It works by preventing cells of the immune system from entering the spinal cord and brain.
A person will require intravenous delivery of ocrelizumab every 6 months. It targets the circulating immune cells that produce antibodies, which play a role in the development of MS lesions.
These include fingolimod (Gilenya) and dimethyl fumarate (Tecfidera).
Fingolimod is a once-daily medication that works by preventing white blood cells called lymphocytes from leaving lymph nodes and entering the brain, blood, and spinal cord.
A person will need to take dimethyl fumarate twice daily. Experts do not know the exact mechanism of this medication.
Some of the most common symptoms associated with benign MS are fatigue, depression, and cognitive impairment. A person may be able to manage these symptoms in the following ways.
A person can follow a daily physical activity program of mild-to-moderate intensity. This program may help reduce fatigue, although a person should avoid excessive exercise.
A person may also reduce fatigue by undergoing occupational therapy. The occupational therapist may help a person learn to walk using an assistive device in a way that saves physical energy.
It is common for people with MS to have depression. The treatment usually involves cognitive behavioral therapy and selective serotonin reuptake inhibitor (SSRI) antidepressants. SSRIs are less likely than other antidepressants to contribute to fatigue.
A person with MS may experience a decline in their ability to think clearly and quickly, and they may have problems with their memory. These issues affect up to three-quarters of people with MS. Medications such as donepezil (Aricept) may be helpful for some people.
Benign MS can become nonbenign. Researchers who carried out a 10-year follow-up of people with benign MS aged below 50 years found that 60% of the participants maintained an EDSS level of three or lower. By definition, therefore, their MS remained benign.
This finding suggests that about 40% of people with benign MS may experience disease progression even after several years of “remission.”
Following a relapse, new symptoms of MS may appear. A relapse can cause new lesions, which, depending on their location, can cause common symptoms of MS to present, such as trembling and muscle spasticity. However, new lesions can sometimes appear without causing symptoms.
As MS is a highly unpredictable disease, benign MS may or may not become nonbenign. The disease affects each person differently.
MS differs from one person to another, making the outlook for a person with benign MS unclear. If benign MS does not affect a person too significantly, a doctor may advise them to defer treatment.
A person will only receive a diagnosis of benign MS if they have been without severe disabling symptoms of the disease for 15 years. However, this does not mean that a person cannot experience a relapse after this time and see their disease progress into a more severe form.
Benign MS is a controversial term with which not all experts agree. People generally use it to refer to a person with MS who has not experienced any severe disabling effects for at least 15 years.
Benign MS is not always asymptomatic, and a person may experience fatigue, depression, and cognitive impairments, among other symptoms.
A doctor may diagnose benign MS if a person has an EDSS score below three for 15 years or longer. They may advise a person with this condition to defer treatment, as MS medications can have severe side effects.
If the disease progresses into a nonbenign form of MS, the doctor may prescribe injectable, infusion, or oral treatments.