Types of MS
What types of MS are there? MS is said to occur in four main forms, but it is still uncertain whether the underlying process is different in these, or whether there are more than four distinct types of multiple sclerosis. Up to 20 per cent of patients are said to have benign MS, but most authorities put this figure at around 6%. This means that they suffer one or two attacks, but either that is all, or they have only very occasional further episodes, and remain active. Often these are people whose first attack was of visual disturbance, or other sensory symptoms. Researchers have suggested however that we probably over-estimate the number of people who have benign disease because we don’t account for subtle problems like cognitive disturbance, fatigue, social and psychological disturbances.1
At the other end of the spectrum of the types of MS is primary progressive MS. This is said to occur in about 10-15 per cent of cases. In this form of MS, people, often middle-aged men, from the first attack, progress relentlessly downhill, usually without obvious attacks or remissions. The other 65-70 per cent or so of people with MS begin with typical relapsing-remitting MS. This means that they have an attack, followed by some recovery, partial or sometimes total, then a period in which they have no further attacks. This period may be called a remission, because the symptoms remit. Remission is a bad term though, because it implies that the disease is not active during this period. We know it usually is, with the development of new lesions in parts of the nervous system that do not cause obvious symptoms. This period of so-called remission is then followed by another attack, or relapse.
Most of these patients end up after some years of relapsing-remitting disease progressing to secondary progressive MS. This is the typical later stage of relapsing-remitting MS, where patients again progress relentlessly downhill, presumably due to continued accumulation of lesion upon lesion. Evidence is coming to light now that, even during periods of so-called remission, damage continues to occur to the CNS. Even though attacks may not be obvious to the person with MS, there may be progressive loss of brain tissue. This may become evident in subtle ways, such as the development of memory problems. The obvious attacks are only the tip of the iceberg, and this is one reason why it is so important to get started with lifestyle changes and therapies to slow down or stop the disease, as early as possible.
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Most of these patients end up after some years of relapsing-remitting disease progressing to secondary progressive MS. This is the typical later stage of relapsing-remitting MS, where patients again progress relentlessly downhill, presumably due to continued accumulation of lesion upon lesion. Evidence is coming to light now that, even during periods of so-called remission, damage continues to occur to the CNS. Even though attacks may not be obvious to the person with MS, there may be progressive loss of brain tissue. This may become evident in subtle ways, such as the development of memory problems. The obvious attacks are only the tip of the iceberg, and this is one reason why it is so important to get started with lifestyle changes and therapies to slow down or stop the disease, as early as possible.
- Amato MP, Zipoli V, Goretti B, et al. Benign multiple sclerosis : Cognitive, psychological and social aspects in a clinical cohort. J Neurol 2006
- Amato MP, Zipoli V, Goretti B, et al. Benign multiple sclerosis : Cognitive, psychological and social aspects in a clinical cohort. J Neurol 2006