Multiple Sclerosis

The course of Multiple Sclerosis (MS) is initally unpredictable for any particular person. While some are only minimally affected by the disease, others experience very rapid progression to total disability. Eventually all MSers spend time between these extremes, for varying periods of time.

In general the younger you are at the official onset of MS, the slower disability progresses. Most of the onset damage is completely repaired and there is little or no initial disability, even when the onset is severely disabling.

However, with or without visible (clinical) attacks, the MS disease process continues. After 10 - 15 years or upon reaching approximately age 40, the number of clinical attacks decline; but disability now becomes increasingly visible, lingers longer, and remissions cease.

Conversely, the older you are when MS clinically begins, the less likely you are to have a complete initial recovery. At first, attacks are more numerous; but this pace lessens very quickly and disability quickly accumulates, before leveling off.

Although every individual experiences a different combination of MS symptoms, there are a number of distinct disease stages and/or types that have historically been identified and recognized, as the naturally occurring course of Multiple Sclerosis.                                      Free counter and web stats

Types and Stages of MS

  • Benign MS
  • Relapsing/Remitting MS
  • Secondary/Progressive MS
  • Primary/Progressive MS
  • Progressive/Relapsing MS

    Diagnosing MS

  • Diagnostic Categories
  • Medical History
  • Neurological Examination
  • Evoked Potentials
  • Magnetic Resonance Imaging
  • Lumbar Puncture (Spinal Tap)

  • MS Symptoms

  • Altered Sensation
  • Balance
  • Bladder
  • Bowel
  • Cognitive/Emotional
  • Fatigue
  • Heat Sensitivity
  • Pain
  • Sexuality
  • Spasticity
  • Speech
  • Visual
  • Weakness

  • Types and Stages of MS

    Benign MS - approx 20%
    After one or two attacks with complete recovery and without any disabilty, this form or stage of MS does not worsen with time and there is no permanent disability or disease progression.

    Benign Multiple Sclerosis tends to follow, non-visible Sensory Symptoms (ie. Dysesthesia, Optic Neuritis, Paresthesias, Paroxysmal) at onset; not Motor Symptoms (ie. Diplopia, InCoordination, Tremor), with a totally complete recovery and no disability.

    However, some in this category will eventually experience disease progression; their course of disease will change and evolve into the Progressive stages of MS, within 10 - 15 years of its official onset.

    Benign MS can only be positively identified, after there is minimal disability (EDSS < 3.0), 10 to 15 years following its official onset. Initially, it would have been categorized as R/R MS.

    Relapsing/Remitting MS - approx 25%
    In this form or stage of MS there are sporadic attacks (exacerbations, relapses), during which new symptoms appear and/or existing ones become more severe. They can last for varying periods (days or months) and are followed by partial or total recovery and remission.

    MS may be clinically inactive (SubClinical), for months or years, between any number of intermittent attacks. However, the disease process is ongoing and damage continues, with or without clinical attacks; microscopic lesions and diffuse damage (Axonal loss) silently proceed.

    This is the most common beginning phase of MS. However, 50% of cases will have progression within 10 - 15 years, and an additional 40% within 25 years of onset; as the disease evolves, into the Secondary/Progressive phase. The clinical signs of progression are:
    1. EDSS score in 4-5.5 range
    2. Increasing relapse rate
    3. PolyRegional relapses (more Functional Systems involved)
    4. Incomplete recovery between relapses (progression)
    5. Decreasing response to Steroids
    6. Decreasing numbers of enhancing lesions
    7. Decreasing NAA levels on MR Spectroscopy
    8. Increasing T1 HypoIntensities ("Black Holes")
    9. Increasing MRI burden of disease
    10. Increasing Axonal pathology
    11. Increasing Spinal Cord lesions

    Secondary/Progressive MS - approx 40%
    Individuals who initially had Relapsing MS (clear-cut attacks and remissions), over time (10 - 15 yrs) the disease pattern changes, evolving into the Progressive stage. Recovery from attacks become less and less complete, deficits increase and disability grows.

    Clinical attacks become less pronounced and remissions tend to disappear; but more CNS tissue has now been destroyed and disability becomes more visible - no remaining unused redundancy.

    This cumulative damage is seen on MRI, as enlarged Ventricles, which is a definitive progression marker for increased Atrophy of the Corpus Callosum, and MidLine Centers.
      S/P MS has two sub-categories
    1. Those continuing to have exacerbations and remissions, retain a R/R MS disease pattern (Inflammatory attacks), and the ImmunoModulatory drugs continue to be effective MS treatments.

    2. Those who no longer have clinical attacks and remissions, become closer to a P/P MS disease course (Non-Inflammatory Axonal loss) and increasing permanent disability.

    Primary/Progressive MS - approx 12%
    This form of MS is characterized by a slow steady onset, usually beginning with walking difficulties; steadily worsening motor dysfunctions and increased disability, but with a total lack of distinct inflammatory attacks.

    Fewer and smaller Cerebral lesions, diffuse Spinal Cord damage, and Axonal loss are the hallmarks of this form of MS. There is continuous progression of deficits and disabilities, which may quickly level off, or continue over many months and years.

    Progressive/Relapsing MS - approx 3%
    This subtype of Progressive MS is more complex; although its overall course mirrors P/P MS in terms of Disability, it differs. It includes periods of acute exacerbations that look like Relapsing MS (having Gd-enhancing T1 lesions), either early on or after many years have elapsed, but lost functions never return.

    Progressive/Relapsing is the most dreaded MS form, it was known as Marburg MS and demonstrates the need for protracted Steroid therapy, with a high mortality rate.

    Symptoms of MS
    Multiple Sclerosis is an extremely variable disease and its symptoms are determined by the combined effects of, which CNS areas have been DeMyelinated and how much Neural tissue has been destroyed, which include both visible and invisible lesions (Burden of Disease).

    There is no universal pattern for the course of MS and every MSer has a different, unique set of symptoms. They vary from time to time and change in severity and duration over time. Most MSers will experience more than one symptom and although there are symptoms common to many of us, nobody ever has them all. What'd You Say, Willis!!

    There Is No Typical MS

    Altered Sensation: "Pins-and-Needles" (Paresthesia), Tingling, Numbness, Itching, or a Burning Feeling (Dysesthesia) in different parts of the body, and indefinable sensations. EEK Smiley

    Balance & Co-ordination Problems: Loss of Balance, Dizziness, Vertigo, Tremor, Unstable Walking (Ataxia), Foot-Drop, Giddiness, Clumsiness, and InCoordination.

    Bladder Problems: Include the need to Frequently and/or Urgently pass water (Spastic Bladder), incomplete emptying or emptying at inappropriate times, and Urinary Hesitation (Detrusor-Sphincter DysSynergia).

    Bowel Problems: Include Constipation, a Slower Digestive System, and less frequently, Loss of Bowel Control.

    Cognitive & Emotional Disturbances: Problems with Short-Term Memory, Concentration, Judgement and/or Reasoning Skills are slowed, but rarely are they totally lost.

    "A marked feature of the pattern of Memory deficits in MS is that Recall, or UnPrompted remembering, is more adversely affected than recognition, or prompted remembering." (D.W. Langdon, PhD; A. J. Thompson, MD, FRCP)

    MS results in Retrieval Failure, rather than a Storage problem, and impaired performance on measures of Conceptual and Abstract Reasoning, Sustained Attention, Information Processing Speed, VisuoSpatial Skills and Verbal Fluency.

    Fatigue: A debilitating kind of overall fatigue which is unpredictable and out of proportion to the activity (Lassitude). Any increase in your body temperature will temporarily make pre-existing MS symptoms worse.

    A good night of sleep does not relieve MS Fatigue and it generally takes a few days of rest, to recover from any over-doing. Fatigue is one of the earliest, most common, and troubling symptoms of MS.

    Heat Sensitivity: Causes a temporary worsening of symptoms and may make your vision blurry (Uhthoff's Syndrome). Body functions normalize, when the body cools off and the Neuron can safely resume transmitting Nerve Impulses.

    Without its Myelin coating, all CNS tissue is more sensitive to heat and prone to stop transmitting electrical signals (Conduction Block), when the body's core temperature is increased by just 0.5C.

    Pain: Is experienced with MS for about 50 - 60% of MSers, e.g. Facial Pain (Trigeminal Neuralgia), L'hermitte's Sign, Headaches, Spasticity (Muscle Cramps and Spasms).

    Sexuality & Intimacy: Impotence, Erectile Dysfunction, Diminished Arousal, Decreased Lubrication secretions, and Loss of Sensation. These dysfunctions are directly caused by MS (DeMyelination, Axonal Loss) in the CNS and ANS that mediate sexual feelings and responses.

    Spasticity: Increased muscle tone is experienced as Stiff, Tight Muscels (Spasticity), which affects mobility and generally includes Muscle Spasms and/or Clonus.

    Speech Dysfunctions: Slowing of Speech, Slurring of words, Scanning Speech, changes in the Rhythm of Speech (Dysarthria), and Difficulty in Swallowing (Dysphagia).

    Visual Disturbances: Blurred Vision (Uhthoff's Syndrome), Double Vision (Diplopia), Optic Neuritis, Afferent Pupillary Defect, involuntary rapid Eye movements (Nystagmus, Oscillopsia), partial Blindness (Scotoma), and very rarely complete Blindness.

    Weakness: usually affects your legs and overall stamina, which quickly makes walking or any sustained activity, extremely exhausting.

    While some of these symptoms are immediately obvious, others such as fatigue, altered sensation, pain, memory and concentration problems are often hidden (invisible) symptoms.

    These can be difficult to describe to others and sometimes family and doctors do not appreciate, the effects that *Clinically Silent* Lesions have on MSers - employment, social acitvities and quality of life. Sad Smiley

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