What Are the Types of Multiple Sclerosis?
Multiple sclerosis (MS) is an autoimmune disorder in which the immune system mistakenly attacks the healthy central nervous system, disrupting the signaling system between the body and the brain. This condition can affect each person differently and is usually unpredictable. There are many types of multiple sclerosis disease, and identifying these MS disease variants can help in proper management and can also help in determining the prognosis. This article emphasizes the different types of MS that help in treating multiple sclerosis.
Before the diagnosis, individuals with possible MS fall into two categories, which are:
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Clinically isolated syndrome (CIS): This includes individuals who have MS-like symptoms for the first time. The MRI (magnetic resonance imaging) may show some signs of MS, but there is not enough evidence to confirm the diagnosis. In this case, the symptoms may last for 24 hours or more. According to the studies, early treatment of CIS can delay the onset of multiple sclerosis. Treatment for severe symptoms includes high doses of steroids and DMTs (disease-modifying therapies).
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Radiologically isolated syndrome (RIS): This includes individuals who show positive signs of MS in the MRI, which is taken for other reasons, but have no symptoms of MS. Essentially, RIS is an incidental finding, meaning it is discovered when imaging is performed for reasons unrelated to suspected MS, such as a head injury, headaches, or other medical issues.
Four types of multiple sclerosis include:
1. Relapsing-remitting MS (RRMS): It is one of the most common types of MS. About 80 to 85 percent of people are usually diagnosed with this form of MS. In this form of relapsing multiple sclerosis, individuals experience symptom flare-ups, meaning that when they experience a relapse, their existing symptoms may increase, or they may have new symptoms. These symptoms persist briefly, and you may remain symptom-free for months or years. If this condition is not treated, it may go into SPMS within ten years in 50 percent of cases. DMTs such as Siponimod and Cladribine are usually considered. Diroximel fumarate, which comes under a class of medication called nuclear factor erythroid 2-related factor 2 (Nrf2) activators, is also used for treating RRMS. Other medications include Interferon beta, monoclonal antibodies, etc.
2. Secondary-progressive MS (SPMS): MS develops as a progression from relapsing-remitting MS. In this form, the symptoms do not flare up or have symptom-free periods like RRMS. Instead, in this form, the disease progresses slowly and progressively. During the initial stage, the symptoms may flare up, which does not entirely go away, and this type is called active SPMS. In later stages, the symptoms worsen slowly and are called non-active SPMS. The active SPMS are treated with the help of DMTs like Siponimod and Cladribine. Other medications include Interferon beta, which is injected into the muscle and helps reduce inflammation. Rituximab can help reduce relapses. Apart from this, lifestyle changes and therapies should also be considered.
3. Primary-progressive multiple sclerosis (PPMS): This type is seen in about 10 percent of MS cases. In this type of MS, there is a continuous progression of the symptoms, or the symptoms worsen progressively from the onset. Additionally, there are no periods of remission or relapse. Ocrelizumab (given via intravenous infusion), which belongs to DMT, is the only FDA-approved drug used in treating PPMS. This injection is given once every six months. Physical therapy, speech-language therapy, biotin supplements, and healthy eating are also considered.
4. Progressive-relapsing multiple sclerosis (PRMS): This is a less common or rare type of MS. This type of MS gets worse steadily from the beginning, but it also has flare-ups, which may or may not improve. Treatment typically includes medications such as corticosteroids, Interferon beta, Ofatumumab, Glatiramer acetate, Mitoxantrone, Teriflunomide, and Ublituximab. Apart from this, lifestyle changes and rehabilitation are also considered.
Other less common forms of MS are:
1. Fulminant multiple sclerosis: Also called malignant MS or Marburg MS, this form of MS progresses quickly with severe relapses, which can occur within five years of diagnosis. The treatment for this is more aggressive than others.
2. Inactive MS: This kind is also called benign MS. Here, the symptoms stay the same even after 15 years. But there may be in the later stages.
3. Burned-out MS: In this type, the MS symptoms may slow down or stop as a person gets older.
What Is the Most Severe Form of Multiple Sclerosis?
Fulminate MS is the most severe kind. It moves very fast and can cause strong flare-ups (relapses) in a short time. This can all happen just a few years after someone finds out they have MS. The symptoms include severe neurological decline that can impact cognition, mobility, and bowel function. MS requires aggressive treatment compared to corticosteroids (administered IV or orally), plasmapheresis (plasma exchange), physical therapy, immunosuppressants, and other therapies.
What Is the Mildest Form of Multiple Sclerosis?
The mildest form of MS is considered benign multiple sclerosis, also called inactive multiple sclerosis. In this type of MS, the attacks are significantly less, with long periods of no symptoms, but in later stages, there may be progression. This type progresses very slowly and is considered very rare. The treatment for this condition involves medications like DMTs and lifestyle changes (diet and exercise).
Conclusion:
Multiple sclerosis can manifest differently in each person. There’s no cure yet, but knowing which type of MS someone has helps doctors take better care of them. Treatment of MS typically involves medications, various therapies, and lifestyle modifications. However, diagnosing MS at an early stage is a difficult task for doctors.
Key Takeaways From iCliniq:
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Multiple sclerosis comes in many different types, and knowing what type it is helps doctors take better care of people and understand how it might get better or worse.
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Relapsing-remitting MS is the most common kind of multiple sclerosis. About 85 out of 100 people who first get MS have this type.
If you have MS and want a care plan made just for you while staying at home, you can talk to our iCliniq neurologist online.
