Multiple Sclerosis (MS) is an autoimmune, inflammatory condition of the central nervous system. Relapsing MS (formerly known as Relapsing Remitting MS) is the most common form and constitutes approximately 85-90% of all cases of MS at the time of diagnosis. Another form of MS is called Progressive MS (PMS). Patients with PMS have slowly worsening courses that do not have typical relapse events. PMS can develop years after RMS is diagnosed or can develop from the start (Primary Progressive MS). Much of the nervous system damage that occurs in MS is due to demyelination (stripping of insulation off of nerve cells), but there is also direct nerve cell death as well.

Relapsing MS: RMS is by far the most common form of MS. It typically presents in early to middle adulthood, with most patients diagnosed between the ages of 20 and 40. The diagnosis is typically made after a patient has suffered from two separate attacks that have caused symptoms consistent with demyelinating events occurring in the central nervous system. These symptoms may be weakness, numbness, imbalance, vision loss or double vision, or difficulty speaking or swallowing. Many patients experience an initial event that is termed Clinically Isolated Syndrome (CIS) and later go on to develop RMS. When patients present with a history, symptoms and physical exam concerning for RMS, we order tests such as bloodwork, Magnetic Resonance Imaging (MRI), Evoked Potentials or a Lumbar Puncture. Once we are confident in the diagnosis of RMS, we usually recommend some form of Disease Modifying Therapy (DMT). The typical course of RMS is one of relapses that consist of new symptoms that develop over a period of hours or days that often persist for up to a few weeks but then significantly improve. There may be periods of remission, or no disease activity, that persist for months or years at a time.

Progressive MS: Previously, progressive forms of MS were divided into Secondary Progressive – arising from prior Relapsing MS – and Primary Progressive – progressive disease from the start. However, it seems that the disease process of progressive disease is very similar in both forms, so the MS community has recently revised our diagnoses into simply Progressive MS. PMS is characterized by progressive decline in function of the nervous system and the progressive accumulation of disability. It tends to affect older patients more than younger patients. There may be periods of relapse events occurring in this disease, but the primary disease activity is that of slow progression. The rate of progression can vary from very slow with stable periods to very rapid accumulation of disability. Currently, we have limited treatment options to help with PMS, but this is an area within MS that is currently undergoing much research – including trials at UAB. Despite inadequate treatments for disease modification, we can help significantly with symptomatic management to help our patients achieve a much higher quality of life.