Overview:


Health care professionals have identified several disease courses of multiple sclerosis.  In reality, these variances are not differing forms of the disease but instead a categorization of severity and/or progression. They describe the current course of the disease.

The pathology of multiple sclerosis tends to be either one of exacerbations (relapses) followed by periods of some levels of recovery from symptoms or in the progressive course less if any recovery from symptoms.

Some people’s MS no matter which type can be more or less aggressive than another perosn’s.  Research is attempting to locate the answers as to why.  In the past few years, several new terms have come in respect to defining these characteristics.  Aggressive Early Onset Multiple Sclerosis (AOMS) is a relatively new term to describe patients newly diagnosed who’s disease pathology appears to be quite aggressive in its pathology.

What is rapidly becoming a clinical paradigm is the sooner multiple sclerosis is diagnosed and the sooner patients move towards disease management the better the outcomes tend to be.

History:

In 1996 four disease courses were originally identified in MS: Relapsing-Remitting MS, Secondary Progressive MS, Primary Relapsing MS and Primary Progressing MS, these disease courses as more has been learned about MS since 1996 have now been updated by the International Advisory Committee on Clinical Trials of MS in 2013.  This can be confusing as you visit websites or attempt to read MS related information online or in books.

The reason for the updated disease course description is over that 17 year span a great great deal more has been learned about multiple sclerosis.  In fact, over those 17 years more has been learned than all other periods of time combined.

The changes in 2013 removed Progressive Relapsing MS and included Clinically Isolated Syndrome (CIS).

The 2013 Revised Types or Courses of MS:

Clinically isolated syndrome (CIS)
Relapsing-Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)

Courses of Multiple Sclerosis Overview:

Clinically isolated syndrome (CIS) is a term that describes a first and single neurologic episode of inflammation in the central nervous system (CNS) lasting at least 24 hours.  People who have an incident of CIS may or may not have it progress towards multiple sclerosis.  Statistically, if plaques appear on a magnetic resonance imaging scan (MRI) that appear similar to plaques associated with MS there is a 60-80% chance of multiple sclerosis.  If the scan does not show plaques or plaques that do not resemble those often associated with MS the statistical risk is 20%. Read More : Detailed CIS Information
Relapsing-remitting MS (RRMS) which is the most common course of the disease. About 80-85% of patients initially diagnosed with multiple sclerosis are diagnosed with RRMS. The course of RRMS is characterized by relapses (attacks or exacerbations in clinical terminology) followed by a time of remission where some levels of symptom recovery occur. Read More: RRMS Detailed Information
Secondary progressive MS (SPMS) signals a change in the RRMS disease course.  In patients who are not on a disease medication to help manage the disease this change statistically happens within 10-20 years from onset of RRMS.  About 50%-80% of RRMS patients not engaging in a disease modifying treatment transition into this disease course.  SPMS is signified by fewer exacerbations, more accrued disability, and less recovery. Read More: SPMS Detailed Information
Primary progressive MS (PPMS) signifies a disease course that has accrued disability, little recovery from disability and is diagnosed at onset of the disease.  About 10-15% of people diagnosed with multiple sclerosis are diagnosed with this disease course. Read More: PPMS Detailed Information

Two other courses of multiple sclerosis do exist but both are much more uncommon and classification of these is still being argued within professional circles.

They are:

Benign MS:

Natural history studies have demonstrated that a certain percentage of people with MS experience a more benign course. However defining “benign MS” and determining the point at which a person can be classified as having a benign course, are the subject of some controversy.  Generally the course of the disease is not benign but instead, may literally take decades to accrue notable disability symptoms.

Malignant or Fulminant MS:

Fulminant MS can be considered similar to relapsing-remitting MS.  The main difference is Fulminant MS develops rapidly, while RRMS can develop over the course of many years.