What to Know About the Different Types of MS

If you have CIS, there is a chance that you’ll go on to have RRMS. But according to Dr. Sy, CIS isn’t really a different stage. “It’s a place where we’re not yet certain about the diagnosis. But at some point, it might meet the criteria of RRMS.”

Dr. Harrington says that when we speak of stages of MS, we’re primarily talking about the conversion of RRMS to SPMS. “And this may be due to biological aging because we know the immune system becomes less active with age,” she adds.

“SPMS is a different stage of MS defined mostly by age and disease duration,” adds Dr. Sy. “As people with RRMS age, they have fewer relapses, but more progression of disability, which happens slowly over time. And PPMS is its own entity in many ways. In PPMS, disability progresses slowly over time without a prior relapsing-remitting history.”

What is the Expanded Disability Status Scale (EDSS)?

Neurologists can use the EDSS to monitor your level of disability over time. The scale ranges from 0 to 10 to represent degree of disability, according to the Multiple Sclerosis Trust. It includes assessment of things such as:

  • Muscle weakness or difficulty moving limbs
  • Balance, coordination, and tremor
  • Problems with speech, swallowing, and eye movement
  • Numbness or loss of sensations
  • Bowel and bladder function
  • Visual function
  • Cognitive function

While the EDSS may be a useful tool, it’s not definitive on its own. So, if your score is higher than last time, it doesn’t necessarily mean it’s permanent.

“I don’t think the disability scale is the best way to categorize someone, because in a severe relapse you can have a high disability score, but it doesn’t mean MS is progressing,” says Dr. Harrington. But it can still be useful in understanding the progression of disability due to MS over time.

What are the treatment options for the different types of MS?

Although there’s no cure, there are lots of treatments for MS, including disease-modifying therapies (DMTs). These medications help to stop the progression of MS.

The National Multiple Sclerosis Society lists 23 DMTs, including injectables, oral medications, and infused medications. These drugs are designed to reduce relapses, delay progression, and limit new disease activity.

“I do believe people who start therapy early have a lower chance of developing progressive MS compared to the 80s, when we didn’t have these therapies and the rates of conversion were higher. We’re doing a better job in controlling it,” says Dr. Harrington.

That said, there are times when it’s best to stop taking DMTs, namely when the risks start to outweigh the benefits. The main reason is related to aging and the risk of infection, as these types of medications suppress the immune system. Frequent UTIs or pneumonia could become a problem, says Dr. Harrington. Another reason to reconsider this type of medication is if your MS converts to the progressive type, and you have other high-risk health issues, she says.

The future of MS treatment is in the details, says Dr. Sy. “We’re really looking for better biomarkers to predict how the disease behaves and to help guide us as to when we can take someone off medication. It’s the idea of precision medicine, but we’re still lacking in this,” he says.