What are the 4 types of MS?

Multiple sclerosis (MS) is a complex condition that affects the central nervous system. There are four main types of MS, and these differ in their progression and outlook.
Learning about the types of MS may help a person gain a better understanding of the condition and its possible treatment options.
MS
MS symptoms occur as a result of the body’s immune system mistakenly attacking the nerve fibers and protective myelin sheath around them. This damage changes the signals that the nerves send to the body and can lead to scarring in the brain and spinal cord.
immune system
can lead to
In this article, learn more about the types of MS, some treatment options, and the outlook for people with this condition.
4 types of MS
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There are four main types of MS. The sections below look at each of these in more detail.
Clinically isolated syndrome (CIS) is often the first episode of MS symptoms that a person experiences. It results from inflammation and damage to the myelin sheath. Doctors will only define the episode as being CIS if it lasts for at least a day.
inflammation
at least a day
In some cases, a person can experience CIS and not have MS. To diagnose MS, the doctor will use an MRI scan to look for active lesions or evidence of past lesions in a person’s brain.
MRI
lesions in a person’s brain
In people who go on to receive an MS diagnosis, the early treatment of CIS may help delay the full onset of the condition.
Learn more about the early symptoms of MS here.
Learn more about the early symptoms of MS here.
Close to 85% of people with MS have relapsing-remitting MS (RRMS). A person will typically experience the first signs of this stage at 20–30 years of age.
85%
relapsing-remitting MS (RRMS)
20–30 years
A person with RRMS will experience episodes of new or worsening symptoms. After each episode, they will have an extended period during which their symptoms improve or disappear until the next relapse. In some cases, however, the symptoms become permanent and only slightly improve during remission.
New lesions often appear on the brain after a relapse. However, they may also appear without causing any apparent symptoms.
The severity of the symptoms can vary depending on the extent and location of the nerve damage. Remission time can range from a week to many years.
a week to many years
During the remission phase, the condition will show no signs of progression.
Primary progressive MS (PPMS) is less common than RRMS. This type of MS occurs most commonly after the age of 40 years.
Primary progressive MS (PPMS)
age of 40 years
People with PPMS have symptoms that gradually worsen over time. They may not have episodes or a sudden onset of symptoms, but they tend to experience symptoms throughout their life without recovery or remission.
A person must experience symptoms that worsen over the course of a full year for a doctor to diagnose PPMS. The severity of these symptoms can vary.
full year
Due to the progressive nature of the condition, some treatments that are effective in treating RRMS are less effective in treating PPMS.
are less effective
After a person has lived with RRMS, the condition may eventually progress to secondary progressive MS (SPMS).
eventually progress
When this occurs, the symptoms will gradually become more severe without any further distinction between episodes and periods of remission.
To receive a diagnosis of SPMS, a person will need to experience deteriorating symptoms, free of relapse, for longer than 6 months.
6 months
SPMS is different from PPMS in that it becomes progressive following periods of relapse and remission. PPMS is progressive from its start.
becomes progressive
Categorizing MS
Doctors may also categorize the activity of MS to help people understand how the condition affects the body. These classifications include:
classifications include
Active: This is a time that includes episodes and new evidence that the condition is progressing.
Not active: This is a period during which the condition is stable, and there is no apparent evidence that it is progressing.
Worsening: This describes a confirmed and notable increase in a person’s disability following a relapse.
Not worsening: This refers to when a person experiences a relapse but shows no new or worsened signs of disability.
People with PPMS or SPMS may experience active or inactive symptoms that are separate from the overall progression of MS. This may include experiencing periods of active symptoms without any condition progression or experiencing few symptoms while the overall course of the condition worsens.
Timeline
The progression of MS will vary from person to person.
will vary
People with RRMS may find that their symptoms gradually worsen with each episode. In some cases, they may get better for months or years at a time. In other cases, the symptoms may remain after an episode and worsen.
After having RRMS, the majority of people not receiving treatment will progress into SPMS. The symptoms typically worsen over time, and the person may stop experiencing cycles of relapses and remissions.
the majority
In rare cases, the condition progresses to advanced MS. This will present with increasingly severe symptoms, including muscle weakness, a loss of mobility, and, in some cases, serious cognitive difficulties.
advanced MS
A person with advanced MS may also lose their physical independence and require continuous care.
MS symptoms
MS affects each person differently, so the symptoms can be unpredictable.
The symptoms of MS can include:
symptoms of MS
fatigue
fatigue
tingling or burning sensations in the body
tingling or burning
vision issues, such as blurry vision or vision loss
vision issues
attention and memory issues
memory issues
dizziness or vertigo
vertigo
difficulty walking
Less common symptoms may also appear, such as:
speech problems
body tremors
body tremors
seizures
hearing loss
hearing loss
breathing problems
In time, these symptoms can lead to secondary complications, including a loss of bone density, bladder and bowel issues, and pressure sores.
bowel issues
Treatment
There is currently no cure for MS, but medical advances have opened new treatment routes. The following sections look at these in more detail.
Treatment for MS typically involves disease-modifying therapy, which can reduce the number of relapses a person experiences and slow the progression of MS.
disease-modifying therapy
Examples include:
beta-interferons, such as Avonex and others
Avonex
glatiramer (Copaxone)
Copaxone
siponimod (Mayzent)
Mayzent
dimethyl fumarate (Tecfidera)
Tecfidera
alemtuzumab (Lemtrada)
Because MS and its progression vary among people, a doctor will tailor treatment to meet a person’s individual needs.
The doctor may also order other prescriptions for MS, including corticosteroid injections to relieve inflammation and symptoms during a relapse.
corticosteroid injections
In addition, the doctor may offer treatment to relieve specific symptoms, such as:
muscle spasms
muscle spasms
bladder and bowel problems
depression
depression
fatigue
Physical therapy can help a person maintain and improve physical strength and the ability to function in everyday life.
Physical therapy
maintain and improve
People may also learn how to use assistive devices.
Plasma exchange may help a person manage severe symptoms of an MS episode if medication has not proven effective.
Plasma exchange
It involves removing blood from the body and extracting substances from it that may be harmful. A doctor then returns the treated blood to the body.
removing blood
This option may help people with relapsing forms of MS.
Some complementary therapies may also help some people deal with their symptoms. These options include:
may also help
mindfulness
yoga
yoga
tai chi
tai chi
reflexology
acupuncture
acupuncture
Pilates
Although these practices are not clinically proven remedies, they may help some people with MS manage their symptoms alongside a broader treatment plan.
Regular light exercise may also help keep the body moving. A physical therapist is likely to recommend stretching after light exercise each day to help keep the muscles strong and flexible.
Outlook
Understanding what to expect with each type of MS can help people get a better idea of how the condition is progressing so that they can seek the best treatment.
Treatment involves managing the symptoms and slowing down the progression of the condition. Ongoing scientific research aims to find new ways to treat MS.
managing the symptoms
Additionally, eating a healthy diet, reducing stress levels, and exercising may all help support an MS treatment plan.
stress
may all help support
Having a support system that understands what it is like to have a diagnosis of and live with MS is vital. MS Healthline is a free app that provides support through one-on-one conversations and live group discussions with people who get it. Download the app for iPhone or Android.
iPhone or Android
Finally, by working directly with a doctor, many people can find a treatment plan that makes it easier to manage their symptoms and track the progression of the condition.
Read this article in Spanish.
Read this article in Spanish