Multiple sclerosis (MS) is an autoimmune disease that occurs when the immune system attacks the protective sheaths around nerves. Relapsing-remitting MS (RRMS) has periods of disease activity and inactivity, or remission.
During remissions, a person may have no or very few symptoms. In general, the symptoms and their severity vary from person to person.
Learning to live with RRMS can be very challenging, but treatments can improve the quality of life and mental well-being.
This article explores RRMS, including its symptoms, diagnosis, and treatment. It also provides questions that can enhance a conversation with a doctor about the condition.
MS is a condition in which the body’s immune system attacks healthy tissue in the spinal cord, optic nerve, and brain, which make up the central nervous system (CNS).
This causes inflammation and damages the fatty substance that protects nerve fibers, which is called myelin. The nerves themselves can also become damaged. As a result, the nerves cannot transmit signals correctly, which can limit the functionality of the CNS. The inflammation may also damage the cells that create myelin, making repairs more difficult.
The relapsing-remitting form is the most common initial diagnosis of MS.
What is RRMS?
RRMS is characterized by areas of small, contained damage to the CNS. This produces different symptoms, depending on the location of the damage.
People with RRMS experience defined periods of new or worsening symptoms, which doctors call “exacerbations” or “relapses.” This is followed by “remissions,” which are periods of partial or total recovery. During remissions, the symptoms may subside or persist, but they do not get worse.
RRMS symptoms vary from person to person, and they can change over time. Some people with MS only experience one symptom, while others experience many.
Some possible symptoms of RRMS include:
- a squeezing sensation around the torso, which is called dysesthesia
- vertigo and dizziness
- walking difficulties
- numbness or tingling
- vision problems
- bladder problems
- constipation or loss of bowel control
- cognitive changes
- sexual problems
- emotional changes
Less commonly, people experience:
- speech difficulties
- hearing loss
- loss of taste
- problems swallowing
- breathing difficulties
To diagnose RRMS, doctors look for evidence that at least two areas of the CNS are damaged and that this damage occurred at different times. The medical terms for this are “dissemination in space” and “dissemination in time.”
To do this, doctors consider:
- the person’s symptoms
- the results of neurological examinations
- cerebrospinal fluid test results
- MRI scans
Doctors must also rule out other health conditions that could be causing the symptoms.
There is no cure for RRMS, but treatments can reduce symptoms and exacerbations. These include:
Steroid medications can reduce inflammation when MS symptoms worsen. A doctor typically prescribes oral or intravenous steroids for a few days to shorten the exacerbation and speed recovery.
Steroids do not appear to have a long-term effect on the progression of MS.
Disease-modifying treatments can prevent relapses or reduce their number.
People can take these drugs orally or via injections. A person might also receive the treatment intravenously, by IV, depending on the type of medication.
These drugs, which are sometimes called DMTs, can cause side effects. Some people tolerate them better than others. It is important to discuss the risks and the best approach to any side effects that might arise with a neurologist.
Diet, exercise, and lifestyle changes
Having healthy habits can make a significant impact on MS symptoms and its progression, as well as on a person’s life expectancy. A person might benefit from:
- quitting smoking
- getting regular exercise, if or when possible
- having a balanced diet
- getting enough sleep
A medical care team, friends, family, and wellness coaches can provide support and assistance. It is also important to have treatment for any other health issues, get vaccinations, and receive preventive care for age-related conditions.
In some countries, doctors use drugs that suppress or modify how the immune system works in order to reduce autoimmune activity. These drugs are known as immunosuppressants.
Immunosuppressants may be a good option for people with frequent or severe relapses, but reducing the activity of the immune system has risks. It is important to weigh the risks and benefits of different MS treatments with a medical team.
A doctor may diagnose RRMS initially and later change the diagnosis to the secondary progressive form of the disease: SPMS.
If someone has SPMS, they experience a gradual worsening of neurologic function. With the transition from RRMS to SPMS, the disease changes from an inflammatory process to a steadily advancing phase of nerve damage or loss.
Within 20 years,
While medications can limit the progression of the disease to some degree, doctors are still unsure about the extent to which they can affect the evolution of RRMS into SPMS. However, research into drugs that target this stage of the disease is underway.
MS progression can be a significant source of anxiety, for people with MS and their loved ones. The National Multiple Sclerosis Society emphasizes the importance of looking after mental health as well as physical health. This may mean:
- eliminating any unnecessary stress
- focusing on problem-solving, whenever possible
- focusing on building or maintaining positive, supportive relationships with family members and friends
- seeking help for persistent symptoms of anxiety or a low mood
The questions below may help a person have a more helpful conversation with their doctor:
- Could I have RRMS?
- How will you test for it?
- What treatment options are available?
- What are the potential side effects?
- What support can I get for staying active and mobile?
- What support can I get for my mental health?
- What else can I do to manage RRMS?
- What happens if my RRMS progresses?
- How does RRMS affect life expectancy?
MS involves the immune system attacking healthy tissue in the spinal cord, optic nerve, and brain. This leads to inflammation and damages nerves and their protective coating.
The symptoms vary from person to person, depending on which part of the nervous system is affected. Someone with RRMS experiences periods in which they have no or few symptoms and other periods when the symptoms worsen.
Medications can reduce inflammation, prevent or reduce exacerbations, and modify the course of the disease. Diet and lifestyle changes can also help.