Course of the Disease

The course of MS is different in each patient. With some people the course of the disease is relatively mild and the disease responds well to treatment; in some other people, the disease may quickly result in their disability without any response whatsoever to the most advanced treatment.

Most patients will be somewhere in between these two extremes. In general, we can describe several basic types of courses of the disease.

1. Relapsing-remitting MS (RRMS)

Relapsing-remitting MS is characterised by alteration of relapses (attacks, exacerbations) and remissions. In most cases (75-85 %), MS starts in this form. Frequent symptoms during the attacks are sensitivity disorders (failures in the sense of insensitivity or reduced sensitivity, a tingling sensation and other unpleasant sensations), problems with mobility, coordination of movements, oculomotor impairments, impairment of sexual and sphincter functions, frequently an inflammation of the optic nerve. In most patients, the symptoms subside within 6-8 weeks but some attacks may leave the patient with a permanent pathological neurological finding or a certain degree of disability. The capability to completely remove the consequences of an attack then usually decreases during the course of the disease. This period of attacks and remissions between them is 5-15 years long on the average. The inflammatory activity at MRI is usually the highest in this stage.

2.Secondary progressive MS (SPMS)

Without treatment, a condition referred to as a “secondary progression” develops in approximately 50 % of patients after an average period of 10 years and in up to 85-90 % of patients after 25 years. This secondary progression is a gradual permanent growth of neurological deficit with clear clinical attacks in the beginning and without them later on. We call this secondary progressive MS (SPMS). The inflammatory activity declines in this period; degenerative processes predominate in the CNS. This type is a direct continuation of the RR period; it is often impossible to distinguish between them exactly. Most patients transitioning into the progressive stage are at level 4-5 on the Kurtzke Disability Status Scale (see below).

3. Primary progressive MS (PPMS)

There are no relapses in the beginning, approximately in 10-15 % of patients. The scope of neurological impairment grows gradually. We call this form of the disease primary progressive MS (PPMS). Typically, it starts after the 40th year in life; it affects men more often than women; the tendency to progression (deterioration) in a single functional system is often observed. The most frequent clinical manifestation is spastic paraparesis with a walking impairment. MRI examinations of these patients mostly show less inflammatory changes; also, the response of these patients to an inflammatory treatment is very low.

4. Relapsing-remitting MS (RRMS)

Approximately 3 % of patients experience a malign (relapsing progressing) course of the disease, which is characterised by severe attacks and progression of the neurological finding with early severe disability.