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What's the typical course of multiple sclerosis?

Multiple sclerosis is recognized as occurring with seven different patterns. With each pattern, a patient experiences a sudden deterioration in normal physical abilities that may range from mild to severe. In most cases multiple sclerosis starts with an acute flare-up of symptoms within hours to days, called a relapse, exacerbation, bout, episode, or attack. Inflammation of an optic nerve (optic neuritis), causing painfulness of eye movement and visual deterioration frequently is

the first symptom. However, not all patients with optic neuritis develop multiple sclerosis. Sensory disturbances such as numbness or tingling sensations are other frequent initial symptoms. In principle, multiple sclerosis can start with any of the symptoms mentioned in the section above.

Especially in early phases of the disease, symptoms frequently decrease or resolve spontaneously within days to months. Therefore, this disease course is called relapsing remitting. New relapses can occur within weeks to many years and can include formerly experienced and/or new symptoms. However, MRI studies have shown that nerve damage can continue in relapsing remitting patients even if symptoms subside. It has long been known that "multiple sclerosis never sleeps". This highlights the importance of preventive treatment if and when it is available. In many cases, the disease course changes after several years and symptoms start to deteriorate slowly with or without superimposed relapses. This course is called secondary chronic-progressive, or just secondary progressive. However, some patients stay in a relapsing remitting course for the rest of their lives.

About 10% of all multiple sclerosis-affected individuals experience chronic progression without relapses from onset of symptoms. This course is called primary progressive and frequently comes along with weakness of the legs, gait and bladder disturbances. Degenerative processes and not inflammation are thought to play the most important role in this clinical disease course. Chronic progression from onset of symptoms with superimposed relapses is referred to as relapsing progressive.

Typically, worsening RRmultiple sclerosis is followed by secondary-progressive multiple sclerosis. During this phase, there are still inflammatory relapses, but in between there is a gradual worsening of symptoms. The onset of SPmultiple sclerosis is when disability really begins to take hold as when people start to slide down the EDSS scale. As a rule of thumb, most people with RRmultiple sclerosis have an EDSS of 3.0 or less whereas most people with SPmultiple sclerosis have an EDSS greater than this. During the whole course of the disease, inflammatory attacks become less and less frequent. Despite this, people with SPmultiple sclerosis continue to deteriorate and eventually move into a secondary progressive phase where there are no more relapses.

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