Sunday, February 22, 2009

What MS Type do I have?

I had a couple discussions come up recently about what type of MS I had and what others had. In doing some research I came across this great breakdown and thought I would post it.

1. Relapsing/Remitting Multiple Sclerosis (RRmultiple sclerosis):
This is characterised by relapses (also known as exacerbations) during which time new symptoms can appear and old ones resurface or worsen. The relapses are followed by periods of remission, during which time the person fully or partially recovers from the deficits acquired during the relapse. Relapses can last for days, weeks or months and recovery can be slow and gradual or almost instantaneous. The vast majority of people presenting with Multiple Sclerosis are first diagnosed with relapsing/remitting. This is typically when they are in their twenties or thirties, though diagnoses much earlier or later are known. Around twice as many women as men present with this variety.

2. Secondary Progressive Multiple Sclerosis (SPmultiple sclerosis):
In this form of multiple sclerosis a person who initially had relapsing-remitting multiple sclerosis begins to develop a gradual deterioration in nerve function, with or without relapses. After a number of years many people who have had relapsing/remitting multiple sclerosis will pass into a secondary progressive phase of the disease. This is characterised by a gradual worsening of the disease between relapses. In the early phases of Secondary Progressive, the person may still experience a few relapses but after a while these merge into a general progression. People with secondary progressive may experience good and bad days or weeks, but, apart from some remission following relapsing episodes, no real recovery. After 10 years, 50% of people with relapsing/remitting multiple sclerosis will have developed secondary progressive. By 25 to 30 years, that figure will have risen to 90%.

3. Progressive Relapsing Multiple Sclerosis (PRmultiple sclerosis):
Progressive relapsing multiple sclerosis shows clear progression in the level of disability from the time symptoms first begin, but with episodes of clear relapses that may or may not be associated with some recovery following the acute episode. This form of multiple sclerosis follows a progressive course from onset, punctuated by relapses. There is significant recovery immediately following a relapse but between relapses there is a gradual worsening of symptoms.

4. Primary Progressive Multiple Sclerosis (PPmultiple sclerosis):
This type of multiple sclerosis is characterised by a gradual progression of the disease from its onset with no remissions at all. There may be periods of a leveling off of disease activity and, as with secondary progressive, there may be good and bad days or weeks. PPmultiple sclerosis differs from Relapsing/Remitting and Secondary Progressive in that onset is typically in the late thirties or early forties, men are as likely women to develop it and initial disease activity is in the spinal cord and not in the brain. Primary Progressive multiple sclerosis often migrates into the brain, but is less likely to damage brain areas than relapsing/remitting or secondary progressive - for example, people with Primary Progressive are less likely to develop cognitive problems.

Other terms often used to describe forms of multiple sclerosis are:
Benign multiple sclerosis: This is a sub-group of relapsing/remitting. It is used to describe the disease in people who have had multiple sclerosis for fifteen or more years without picking up any serious and enduring disability. One of the neurologists that I saw put it at ten years. It's a bit of a false label really and people with benign multiple sclerosis are often reclassified as Secondary Progressive after a number of years [Hawkins and McDonnell, 1999].
Malignant multiple sclerosis: Also known as Marburg's Variant and Acute Multiple Sclerosis. This is a label given to forms of multiple sclerosis where the disease progresses very rapidly from onset leading to severe disability within a relatively short period of time. Fortunately, this form of multiple sclerosis is extremely rare.

Chronic Progressive multiple sclerosis: Primary Progressive and Secondary Progressive used to be lumped together as Chronic Progressive (CPmultiple sclerosis) but this term is no longer officially recognised although you will still see it referred to now and then.

Transitional/Progressive multiple sclerosis: Another form of the disease which is sometimes referred to but not widely used, is Transitional/Progressive (TPmultiple sclerosis). This is characterised by a progressive course beginning many years after an isolated bout.

Devic's Disease: Also known as Neuromyelitis Optica, Devic's disease is a related condition to multiple sclerosis that is characterised by an attack of Optic Neuritis in both eyes followed by severe inflammation of the spinal cord (Transverse Myelopathy).

Balo's concentric sclerosis: This is another very rare disease that resembles multiple sclerosis. Clinically, it is very hard to distinguish Balo's concentric sclerosis from multiple sclerosis but MRI scans show the lesions in Balo's to be concentric rings of intact myelin and demyelinated zones. It is more common in China and the Philippines than elsewhere.


  1. Thanks for this post. This is one of the best examples I have seen. It is very difficult to try and explain or even understand the various versions of MS.

  2. nice article… simple and useful :)