No matter what type of MS you have, the way in which it progresses can be unpredictable and totally different to somebody else’s experience. In fact, some people living with multiple sclerosis will go on to live with only mild symptoms after their diagnosis, whereas for others, MS may be a rapidly progressive condition. MS has different stages and people can pass through some of them, or all of them.
- Quick facts
- Without treatment, people living with MS may go through several key stages: radiologically isolated syndrome (RIS) where damage shows up on a brain scan but there are no symptoms or clinically isolated syndrome (CIS) where a person has one initial attack of symptoms; relapsing remitting MS; and then secondary progressive MS
- Patients who are treated for MS three years after onset are more likely to have difficulty walking sooner, compared to those who started treatment within one year
- Damage can be taking place to the brain in the early stages of MS that might not cause noticeable symptoms
- Over time this damage can build up and cause symptoms and can lead to worsening disability
- How RRMS progresses over time
Of course, everybody is different, MS can progress through these key stages and types of MS:
Radiologically isolated syndrome (RIS): At this stage, there are changes in your brain that may look like MS, but no noticeable symptoms to indicate a problem
Clinically isolated syndrome (CIS): You’ve had one isolated attack of symptoms that may appear to be due to MS, but you can’t yet be diagnosed with MS
Relapsing remitting MS (RRMS): You’ve had another attack of symptoms (called a relapse), which helps your doctor or MS nurse to confirm a diagnosis. RRMS is characterised by relapses (periods of worsening symptoms) followed by remissions (extended periods of good or complete recovery). You might also hear your doctor or MS nurse mention something called the McDonald criteria, which can help them to make a diagnosis after only one relapse if they have enough information from your MRI scans
Secondary progressive MS (SPMS): Without the right treatment, 50-60% of people living with RRMS will go on to develop SPMS within 15 to 20 years after their MS diagnosis. SPMS is characterised by a progressive decline in function and increase in disability – with or without periods of relapse and remission.
- Early on in MS
It can be good to understand what’s going on in the brain in the early stages of MS, especially when you’re working with your doctor or MS nurse to choose the best way for you to manage your multiple sclerosis.
Early on in the condition, the brain may find ways to partially compensate for damaged nerve cells by using other pathways to send signals from the damaged parts of the brain to undamaged regions. In doing so, messages can be restored between your brain and the rest of your body. The brain also attempts to cope with nerve cell loss by repairing myelin, a process known as remyelination. However, because these repair mechanisms can mask symptoms, some patients may go undiagnosed and untreated in the early stages.
- Build-up of damage in multiple sclerosis
Everyone’s brain very gradually starts to shrink as they get older. This is sometimes called brain atrophy or brain volume loss (BVL). It’s a normal part of aging, but it can happen a little faster in people living with MS.
It is not known why MS leads to an accelerated reduction in the brain. Possible explanations for this are:
Your body tries to repair the protective myelin coating, which gets damaged in MS. But the body’s repair process is far from perfect and as time goes on, it’s not enough to prevent further damage to the nerve cells. As this damage continues, using other pathways in your brain can no longer compensate for nerve loss as areas of damage become too large. This may result in brain atrophy.
As MS progresses, parts of your central nervous system (CNS) can start to become permanently blocked. It’s at this point that disability can continue to worsen over time, with or without relapses, and you enter a stage called secondary progressive multiple sclerosis (SPMS).
Without effective treatment, 50 to 60% of people living with RRMS will go on to develop SPMS within 15 to 20 years.
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