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A deep examination of the 3 kinds of multiple sclerosis and their stages, plus how to know the differences.

Multiple sclerosis is a very individualized disease, meaning that each patient has a very different and unique experience with it. This makes it difficult to explain fully to any single patient, since every path varies. While every form begins with the very basic idea that it is caused by some form of nerve damage, and it is known that this is an autoimmune disease that comes from the body’s malfunction in attacking itself, far little from that remains the same for each person.

However, there are some generalizations that can be made based on dividing MS into four types and also describing severity by stages, much like cancer. To better understand the difference, it’s important to know something about each type of multiple sclerosis and how stages are determined.

Relapsing-remitting multiple sclerosis

By far the most commonly diagnosed type of MS, even patients who may eventually discover they are categorized with another type of the disease are often first diagnosed with RRMS. The first signs of related symptoms are typically seen when patients are in their early to mid-twenties, with the most common ones being:

  • Vision issues
  • Numbness of the feet
  • Weakness, especially in the legs
  • Chronic fatigue
  • Frequent, urgent need to urinate
  • Trouble with balance or coordination
  • Difficulty with cognizance
  • Sensitivity to heat

With relapsing-remitting multiple sclerosis, symptoms will come and go. A relapse means that symptoms return for at least 24 hours, but then they dissipate or go into remission. This could mean that symptoms lessen or go away entirely for a period of days, weeks, or even months in some cases.

While this could continue throughout life, most patients initially diagnosed with RRMS will eventually be diagnosed with secondary progressive MS.

Secondary progressive multiple sclerosis

Eventually, most RRMS cases shift to SPMS, though the reason or specific timing for the shift is unclear. In secondary progressive MS, the many years of remission cease, and the symptoms are continually active. They begin to march slowly forward over time, worsening with the length the disease has been present.

Some factors that come into play with SPMS are:

  • Age of an individual when diagnosed with relapsing-remitting multiple sclerosis – in most cases, the older the patient is when first diagnoses, the shorter the time prior to progressing to this more “full” type of MS.
  • Ability to recover/remiss after a relapse – those who have difficulty fully recovering, or experiencing “complete remission” with symptoms disappearing entirely, are more likely to move into SPMS more rapidly.
  • How progressive nerve damage is – because relapsing-remitting multiple sclerosis begins with mainly inflammation around the nerves that causes loss of function that later progresses into less protective inflammation and more true damage to the nerves themselves, this could affect how quickly a patient moves on to secondary progressive MS.

Primary progressive multiple sclerosis

With PPMS, there is no “grace” period of symptoms that relapse and remit. Instead, they are constant and progressively get worse over time from the very beginning. Unlike RRMS, which appears in women over men in a ratio of three to one, equal numbers of each gender appear to have this form of the disease, which is often not diagnosed till an average age of forty.

While each patient has their own unique experience, PPMS seems to worsen more rapidly, causing eventual disability much sooner than relapsing-remitting multiple sclerosis. As with SPMS, there is not a lot that can be done to treat, other than some management skills and therapies, as well as medications to manage various symptoms.

Progressive relapsing multiple sclerosis

This type of MS is extremely uncommon and, in fact, there are so few patients doctors know little about it. While this form has the same cadence as relapsing-remitting MS, where symptoms come and go, it also progresses similarly to PPMS or SPMS, in that, every time the patient relapses and symptoms return, they worsen.

Stages of multiple sclerosis

Because the symptoms are experienced differently – by order, severity, etc. – in patients, it’s hrd to define specific stages of progression in any type of multiple sclerosis with the accuracy of a guide such as what is available for cancer patients. However, there are some categorizations that help with diagnosis and identification for particular acts of the disease within the body.

  • Active vs. Not Active – Active refers to signs that the disease is actively progressing, including particular attacks or new evidence of symptoms, whereas patients are mostly stable without any new activity from the disease when it is Not Active.
  • Worsening vs. Not Worsening – If there is sign of notable increase in a disability following a relapse, this is referred to as worsening, whereas a lack of evidence or confirmation of no more severe disability than prior to the relapse is referred to as Not Worsening.
  • Relapse – When symptoms haven’t been exacerbated for at least thirty days and flare up for more than 24 hours, this is called a relapse. Prior symptoms may return, or new symptoms may appear. The length of a relapse varies, but should be followed by a period of remittance that returns the body to its state prior to the relapse.
  • Remittance – When the body returns to the state of being that existed prior to the relapse, returning to the same level of “normal”, this is called remittance. It is not a cure or an end to the disease but it is a relief from the symptoms for anywhere between days and years, depending on the type and severity of MS is in question.


There are treatments to help slow the progression of multiple sclerosis, as well as therapies and treatments designed to help with symptoms experienced and to control the frequency of flare-ups. However, there is no cure for MS of any kind, and one of the best ways to manage the early stages of the disease are to assure proper amounts of quality sleep, eating a healthy diet that keeps the body functioning well, and moderate exercise that doesn’t cause overheating, thereby leading to an exacerbation of the ailment.

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