Multiple Sclerosis? What Type Are You?

The more knowledge we have about our incomprehensible disease, the monster that has invaded our lives, the more we are empowered to accept and handle it.

Relapsing/Remitting MS (RRMS)
Most people, including me, who are diagnosed with MS have the Relapsing/Remitting type. This is the MS that is most recognized, identified by periods of relapse followed by periods of remittances or complete recovery. At any given time, approximately 55%-85% of MSers have RRMS. Relapsing/Remitting MS is the type most MSers have, at least at first,and these are the ones who often know their type -- but not always. Clinical trials and disease-modifying drugs most often apply to RRMS.

Chronic Progressive
Until recently, anyone who did not have RRMS was told they have Chronic Progressive MS. All of us have Chronic MS. This is label that includes all progressive forms of MS.

In Progressive MS, there is a gradual worsening of symptoms. Progression is measured by loss of function as well as increase in lesions. However, Chronic Progressive MS is further characterized by defined, distinctive subtypes.

Secondary Progressive MS (SPMS)
Just as it takes time after the initial symptom presentation to get a definite diagnosis of MS, time is also a major factor in developing and identifying a type as Secondary Progressive. It is often difficult to determine exactly when the MSer crosses the threshold from RRMS to SPMS, but the difference between the types is clear.

When Relapsing/Remitting precedes a progressive form of MS, it is Secondary Progressive. That time period varies from as short as two years, to as long as forty years. At any given time, Secondary Progressive accounts for 30-40% of all MSers.

In the beginning of Secondary Progressive MS, there is a gradual worsening between relapses. There may still be relapses and remittances, but not as strong or obvious as before. After awhile there are no relapses and definitely no recoveries, but general progression of the symptoms continues. That is Secondary Progressive MS. This is now my MS.

Primary Progressive MS (PPMS)
If there is no period of initial Relapsing/Remitting before a progressive course, it is likely to be Primary Progressive MS. Somewhere between 10% and 15% of all MSers have PPMS. It is a steady progression of greater affliction with little or no recovery. Basically, Primary is quite similar to Secondary, without a previous period of Relapsing/Remitting.

Primary Progressive MS is generally diagnosed about one or two years after the initial presentation followed by progression of symptoms and some degree of disability. Though similar to Secondary, is unique. It is identified usually in late 30s or early 40s, affecting men as likely as women, and it usually attacks the spinal cord rather than the brain.

Progresssive Relapsing (PRMS)
Around 3-5% of MSers have a steady progression of neurological damage accompanied by clear periods of relapse followed by significant recovery. This form is similar to Relapsing/Remitting, but with the addition of accumulated damage between relapses. Sometimes this course of the disease progression is thought to be Primary until punctuated with relapse, and remittance ranging from full recovery to very little.