Disease Course of MS

Disease Course

Multiple sclerosis is highly variable and unpredictable from person to person.

1. Benign Multiple Sclerosis

• Disease in which the patient remains fully functional in all neurological systems 15 years after onset.

1. Malignant Multiple Sclerosis/Marburg Disease

• It is a rare disease course characterized by rapid onset and progression leading to disability or death within a short time after onset.

There is 4 major clinical course

1. Relapsing-Remitting Multiple Sclerosis (RRMS)

1. Characterized by separate attacks of neurological deficit (relapse) followed by partial or full recovery (remission) in certain weeks to months.
2. Periods between relapses are characterized by a lack of disease progression.
3. The stable patient may have a local inflammatory activity that is clinically silent.
4. RRMS affects approximately 85% of patients with multiple sclerosis at diagnosis.

Fig. 1: RRMS

2. Secondary Progressive Multiple Sclerosis (SPMS)

1. Characterized by an initial relapsing-remitting course followed by a change in clinical course with progression to steady and irreversible decline with or without continued acute attacks.
2. May be the result of progressive axonal loss rather than new lesions.
3. 90% of cases of RRMS are progressed to SPMS in 25 years.

Fig. 2: SPMS

3. Primary-Progressive Multiple Sclerosis (PPMS)

1. Characterized by continuous worsening of the disease from the onset.
2. Patients may experience fluctuations in neurological disability but distinct attacks do not occur.
3. PPMS is associated with letter onset (mean age 40 years) and more equal gender distribution.
4. PPMS affects approximately 10% of patients with multiple sclerosis.

Fig. 3: SPMS

4. Progressive-Relapsing Multiple Sclerosis (PRMS)

1. Characterized by study deterioration in disease from onset (similar to PPMS) but with occasional acute attacks.
2. Intervals between attacks are characterized by continuing disease progression.
3. PRMS affects approximately 5% of patients with multiple sclerosis.