A more visual explanation of the progression of MS can be helpful for understanding your symptoms and the type of MS you currently have.
Over the past few decades, the quality of life and life expectancy for people with multiple sclerosis (MS) has improved significantly.
MS is a neurological condition that affects nearly 1 million U.S. adults, reports the National MS Society. New medications have slowed the progression of the condition.
People with MS generally experience a progression of MS symptoms and severity throughout their lives. There are four types of MS. They’re defined by the frequency and progression of symptoms:
There’s no one set timeline or course of MS, but knowing the type can help you understand and manage your MS.
| MS stage | Features |
|---|---|
| Clinically isolated syndrome (CIS) | 1. An episode of neurological symptoms lasting at least 24 hours. 2. Diagnosed after a single episode. 3. An MRI shows one area of myelin damage from the episode. 4. More than one area of myelin damage indicates a different MS type. |
| Relapsing-remitting MS (RRMS) | 1. Involves a pattern of relapse and remission. 2. People with RRMS often have fewer symptoms during remission periods. 3. Symptoms worsen significantly during relapse and can be disabling. 4. The pattern and timing of remission and relapse is unpredictable. 5. Might progress to cause more severe symptoms during relapses. 6. Can get more difficult to manage over time. 7. Can progress to secondary progressive MS. |
| Secondary progressive MS (SPMS) | 1. Involves an irregular progression of symptoms. 2. More aggressive than RRMS. 3. Might have periods of remission. 4. Effects of the disease increase and are more severe with each relapse. |
| Primary progressive MS (PPMS) | 1. Slow and steady progression of symptoms with no remission periods. 2. The most rarely diagnosed form of MS. 3. Symptoms might plateau but will not disappear. 4. Progressive difficult walking is common in PPMS. |
The disease progression in MS can also be measured on the
- visual function
- bowel and blade function
- muscle control and strength (pyramidal)
- balance and coordination (cerebellar)
- speech and swallowing
- thinking and memory
- sensory function
- all other difficulties
The early stages of MS might only cause mild symptoms in one or two of the functional systems. As MS progresses, more systems are more severe, and more systems are affected.
Having MS doesn’t mean you’ll progress through every status on the EDSS. In fact, two-thirds of people with MS will retain their ability to walk and will never pass status 7.
Here is a breakdown of the scale:
| Stage | Features |
|---|---|
| 0 | No disability. |
| 1 | Minimal symptoms affecting one functional system, but no disability. |
| 1.5 | Minimal symptoms affecting more than one function system, but no disability. |
| 2 | Minimal disability symptoms in at least one functional system. |
| 2.5 | Mild disability symptoms in one functional system or minimal disability in two functional systems. |
| 3 | Moderate disability symptoms in one functional system, or mild disability in three or four functional systems. No difficulty walking. |
| 3.5 | Moderate disability in one functional system and more than minimal disability in several others. No difficulty walking. |
| 4 | Significant disability but able to perform self-care activities and live independently. Able to walk without assistance or rest for at least 500 meters (1,640 feet). |
| 4.5 | Significant disability and some limits to the ability to perform daily tasks. Still able to work and independently do most activities. Able to walk without assistance or rest for at least 300 meters (984 feet). |
| 5 | Disability is significant enough that daily activities are affected. Might need assistance to work or perform self-care. Able to walk with assistance or aid for at least 200 meters (656 feet). |
| 5.5 | Disability is significant enough that self-care and other daily activities might not be possible. Able to walk without assistance or rest for at least 100 meters (328 feet). |
| 6 | Need a walking aid but can walk 100 meters (328 feet) without resting. |
| 6.5 | Needs two walking aids but can walk 20 meters (66 feet) without resting. |
| 7 | Uses wheelchair exclusively but able to transfer self in and out of the wheelchair. Able to use a wheelchair independently. No longer able to walk more than 5 meters (16 feet) even with aid. |
| 7.5 | Might need help transferring in and out of a wheelchair. Might require a motorized wheelchair. Unable to walk more than a few steps. |
| 8 | Needs assistance to use a wheelchair. Still able to use arms and perform some self-care. |
| 8.5 | Restricted to bed for most of the day. Still has some use of arms for self-care. |
| 9 | Unable to leave bed. Able to communicate and eat. |
| 9.5 | Unable to leave bed. Needs full-time caregiving and unable to communicate. Cannot eat or swallow independently. |
| 10 | Death from MS. |
Every MS timeline is unique to the individual person with MS. Not everyone who receives an MS diagnosis will have their condition progress at the same rate or experience all types.
For example, some people with relapsing-remitting MS (RRMS) never progress to any other type of MS. They might not have severe symptoms or notice any progression of their MS. Other people might experience a steady worsening of their symptoms.
Clinically isolated syndrome (CIS)
Doctors diagnose CIS after a single symptomatic episode. Inflammation and damage to the myelin of the nerves in your brain or spinal cord causes a CIS episode.
For a diagnosis of CIS, the episode must last for at least 24 hours and cause neurological symptoms, such as:
A doctor will likely order an MRI to help them make a diagnosis. They will classify your condition as CIS if the MRI only shows a single area of myelin damage. However, if the MRI shows more than one area of myelin damage, your diagnosis will be another classification of MS.
Relapsing-remitting MS (RRMS)
RRMS follows a pattern: You experience defined flare-ups or relapses of your symptoms, and you also have periods of remission when you return to a baseline with fewer MS symptoms.
Over time, the symptoms you experience in relapses can worsen. Your MS might become harder to treat and manage. You might still experience some symptoms during remission.
Symptoms you’re likely to experience during relapses include:
- fatigue
- vision problems
- weakness
- numbness
- tingling
- dizziness
- pain
- confusion or other cognitive difficulties
- difficulty walking
- vertigo
Secondary progressive MS (SPMS)
RRMS can progress to SPMS. In SPMS, MS progresses over time with a sporadic, unpredictable pattern. You might still have times of remission, but there will be a worsening of your symptoms with each relapse.
The symptoms of RRMS and SPMS are the same, but the progression looks very different. The worsening of symptoms is the primary difference between RRMS and SPMS.
Primary progressive MS (PPMS)
Only about 10% to 15% of people with MS have PPMS, reports the MS Society.
The disease progression in PPMS is slow and unpredictable. There are no remission periods. Symptoms might plateau for a period of time and be easier to manage, but they will not disappear.
Increasing difficulty walking is very common in PPMS. The exact rate of progression depends on your individual case.
MS has no current cure, but treatment options can slow the progression and manage your symptoms.
There are a variety of treatment options. Your doctor might advise you to make lifestyle changes, take over-the-counter (OTC) medications, or take prescription medications.
The best treatment plan will depend on your symptoms and how your MS is progressing. Your doctor will work with you to find the right treatment plan for you.
Lifestyle changes that can help MS include:
- eating a well-balanced diet
- reducing stress
- adding movement to your day
- stretching often
- trying acupuncture, yoga, meditation, or guided relaxation
- working with a physical therapist
OTC medications include:
- pain relief medications, such as naproxen, aspirin, or ibuprofen
- laxatives and stool softeners
Prescription medications include:
- corticosteroids to reduce inflammation during a relapse
- plasma exchanges
- disease-modifying therapies to reduce the frequency and severity of relapses
- muscle relaxants for pain management
An MS diagnosis can be overwhelming. As you learn about the condition and your treatment options, it’s equally important to find support and take care of your mental well-being.
Some great places to turn include:
- reaching out to an MS navigator for professional help finding support and resources
- finding local support groups and events
- getting free emotional support 24/7 using the Happy App
- joining the MSFriends Helpline to get matched with one-to-one peer support
MS is a chronic condition that can change and progress with time. Every case of MS is unique. Not everyone will go through every stage of progression, and there is no set timeline. Knowing the type of MS you have can help you know what to expect and help you manage your condition.
With the right tools, you can slow the progression of your MS and get symptom relief.