Multiple sclerosis (MS) is a progressive condition, meaning it will generally get worse over time. However, many people experience periods of remission that can last a long time.

MS affects people in various ways because it can damage many different areas of the central nervous system. Some people develop a progressive form of MS, while others develop relapsing-remitting MS (RRMS).

In RRMS, it is possible for a person to experience periods of remission that can last for weeks to years. Relapses — periods in which symptoms worsen — can follow periods of remission. Progressive forms of MS often involve a slow development of disabilities that gradually worsen over time.

This article answers the most commonly asked questions about MS remission and progression.

About 70–80% of people living with MS have RRMS at the time of diagnosis. This subtype of MS involves periods of worsening symptoms (relapse) followed by partial to full recovery (remission).

In a 2023 study, researchers found that out of nearly 9,000 people with MS, only 113 experienced a relapse in a 3-month period. They reported a low annual relapse rate in the study group. The relapse rate in this study was lower than those in previously reported studies.

Relapses can also occur in progressive forms of MS.

Relapses typically follow a pattern. New or recurrent symptoms develop over a few days to weeks, and the symptoms typically improve within 24–48 hours of starting. Improvements can occur with or without treatment.

However, relapses can also contribute to worsening disability, as they sometimes leave residual symptoms.

Most people with MS start out with RRMS. According to the National MS Society, 85% of people with MS initially receive an RRMS diagnosis.

In between relapses, MS does not appear to worsen or change. However, a person may find that their RRMS changes into a progressive form of MS over several years.

Progressive forms of MS involve a slow or gradual worsening of disabilities.

Primary progressive MS (PPMS) is a progressive form of MS. About 15% of people with MS receive a diagnosis of PPMS.

Another progressive form of MS is secondary progressive MS (SPMS). At this stage, neurologic function worsens over time and disability increases.

According to the National MS Society, past research suggested that half of people who received a diagnosis of RRMS would transition to SPMS within 10 years and 90% would progress within 25 years.

New therapies may help prevent progression. According to a 2020 review, a newer type of treatments called immune reconstitution therapies may help promote long-term or potentially permanent drug-free remission in people with MS.

These therapies help deplete the immune system with the goal that it will rebuild itself. In this way, the immune system may stop mistakenly attacking the central nervous system.

Some spontaneous myelin repair occurs, at least partially, in all lesion types. However, the extent of the repair can vary considerably depending on the lesion types and people’s physiology.

Current treatments do not address myelin repair, but this may change in the future.

The MS Society UK is currently sponsoring a trial to determine whether metformin — a diabetes medication — may help repair damaged myelin. Studies on novel treatments may find ways to help repair nerve damage.

MS can enter remission with or without treatment.

Treatments help slow the progression of MS, prevent the formation of new lesions, and reduce the severity of symptoms. A person should start treatments as soon as possible after their initial diagnosis to help lower the risk of disability.

Future treatments may help repair nerve damage and restore function.

Yes, the body can repair the myelin sheath on its own. All lesion types can experience repair.

However, there are considerable differences among people and lesions and how well they repair themselves.

According to a 2021 review, some peoples’ bodies repair myelin well and others do not. Researchers do not understand why this disparity occurs.

Genetic and environmental factors may both play a role. As researchers come to understand more about how the body repairs myelin, they may be able to develop novel treatments that may help repair damage associated with MS.

Many people believe that MS is a relentlessly progressive disease that will leave a person disabled within only a few years. However, this is not generally true.

According to an older 2003 article, 60% of people with MS remain able to walk and one-third do not have any significant disability.

Several factors can influence the overall severity and potential outcomes of MS. Factors associated with a favorable outcome include:

  • relapsing course
  • female sex
  • good recovery between relapses
  • mild relapses
  • a long interval between the first and second relapse
  • optic neuritis (inflammation of optic nerves causing vision changes or eye pain)
  • primarily sensory symptoms
  • full recovery from relapses
  • low lesion load on MRI

Factors associated with a less favorable outcome include:

  • high early relapse rate
  • male sex
  • imbalance and gait issues
  • progressive course
  • frequent relapses with minimal recovery in between
  • symptoms that start in multiple locations in the body
  • large lesion load and brain atrophy on MRI

Though these factors may influence MS, they do not mean a person will or will not develop a disability due to MS. But they can help a person get an idea of how severe the condition is and may become.

MS can go into remission with or without treatment. However, treatment can help slow the progression of the disease and reduce the severity of symptoms.

Researchers are looking into new treatments that may help repair damage associated with MS.

MS remission typically happens within a day or two of the start of new or worsening symptoms. During remission, a person will often not have any worsening of the disease.