Most of us know there are four types of multiple sclerosis; Relapsing Remitting (RR), Secondary Progressive (SP), Primary Progressive (PP) and Progressive Relapsing (PR). Did you know those types of MS were defined back in 1996?
Twenty years ago the US National Multiple Sclerosis Society Advisory Committee on Clinical Trials in Multiple Sclerosis defined those four clinical types of MS. They were defined to help provide homogeneous language and clarification among clinicians and individuals with MS.
In 2014, the American Academy of Neurology published an article updating the titles and descriptions of the types of MS. In 2012, a committee took look at the advances in technology and the way we look at MS and brought to us some new definitions. The said committee wanted to keep the basic features of the original four types, however, with some modifications. In the end, they defined four types of MS; Clinically Isolated Syndrome (CIS), Relapse Remitting (RR), Primary Progressive (PP) and Secondary Progressive (SP).
Clinically Isolated Syndrome: This is now recognized as the first sign of MS. This is where the body shows signs of demyelination and inflammation but hasn’t met all the criteria for a MS diagnosis. A brain MRI is done to look for lesions and help decide whether MS is an appropriate diagnosis. If the MRI shows lesions, then the person is likely to develop more symptoms and a diagnosis. Patients with CIS can begin treatments to help delay the onset of MS.
Relapse Remitting MS: This is still the most common type of MS. However, they now characterize RRMS as active, not active, progressing, or no progressing. If an MS patient has an MRI with contrast that shows new activity, they would now be considered RRMS –active. If there is no new activity on the MRI, it would be RRMS – not active. The progressive part comes in when there is an increase in disability. No increase in disability would be no progression, where and increase in disability would be considered progressing.
Primary Progressive MS: PPMS represents what use to be progressive relapsing MS. This type still shows worsening neurologic functions, however, can now be classified as active, not active, with progression or without progression. Very similar to RRMS, new MRI activity or relapses would be considered PPMS – active, where no changes would be PPMS – not active. Evidence of disease worsening would be considered PPM – with progression and no signs of worsening would be PPMS – without progression.
Secondary Progressive MS: SPMS is the gradual deterioration after the initial relapse. Most of the time people transition into this group from the RRMS category. Like the last two groups, SPMS can be categorized as active, not active, progressing, or not progressing. SPMS – active would include relapses and new MRI activity, where no activity is SPMS – not active. SPMS – progressing would include continuous worsening of the disease over time, where no changes would be considered SPMS – not progressing.
What do you think of the new definitions?
Vanessa is a 28 year old living in Massachusetts with her husband and 7 year old Puggle, named Rocky. She currently works in an elementary school and as a fitness instructor and health/fitness coach. She was diagnosed in April of 2014 with relapse-remitting MS and is currently taking Tecfidera. She enjoys being outdoors, spending time with her family and friends, reading, and traveling.