The main types of multiple sclerosis (MS) are four: relapsing-remitting, primary progressive, secondary progressive, primary progressive with exacerbations. In 2013, two new types of the disease were added. The first was the clinically isolated syndrome (CIS). It is the form of MS that determines the treatment.
There are four main typestypes of multiple sclerosis( SM ,sclerosis multiplex ), the most common is a relapsing-remitting form of MS in which periods of symptom occurrence are interspersed (at least initially) with periods of stabilization without neurological deviations. Diagnosing the correct type of MS in a patient is important primarily because different types of this disease are characterized by different responses to the treatment. Multiple sclerosis (MS,sclerosis multiplex ) is considered the most common in neurology, an inflammatory demyelinating disease. Different patients may be diagnosed with the same disease - that is, MS - but the course of the disease may be completely different. This is why there is a division into the four basic forms of multiple sclerosis. The classification of the disease types was introduced by the American National Multiple Sclerosis Society in 1996. Less than twenty years later, because in 2013, the original classification was re-analyzed - the previously established division was generally maintained, and some additional elements were added to this classification.
Types of MS: relapsing-remitting form
Relapsing-remiting multiple sclerosis MS or RRMS for short (derived from the English namerelapsing-remiting multiple sclerosis ) is the most common type of the disease - it is found in up to 85% people diagnosed with multiple sclerosis. This type of MS has periods of relapses. A relapse is defined as having different symptoms of MS that last for a minimum of 24 hours. Various ailments may occur in the patient both for the first time, and in the relapse, the neurological deficits already existing in the patient may worsen. It should also be emphasized how it is determined whether the patient's complaints belong to the same MS attack or notthey are also already associated with the next flush. In order to be able to talk about a patient's next bout, there must be a minimum of 30 days of pause from a previous MS exacerbation. A MS flare-up may be immediate, but more often symptoms worsen gradually over a period of 24-72 hours. The duration of a single disease bout varies, the symptoms usually disappear gradually within a few to several weeks. Characteristic of the initial course of RRMS is that patients do not usually experience neurological deficits after relapses have resolved. In addition to relapses, RRMS is associated with remissions, i.e. periods in which patients are stable. Usually (especially in the first years of the disease) during remission, patients do not experience neurological deficits. Over time, patients may experience varying degrees of MS symptoms after relapses, eventually leading to a persistent degree of disability and increasing neurological deficits.
Types of MS: Secondary Progressive Form
Secondary progressive multiple sclerosisis the second most common type of MS, or SPMS for short. It occurs in people initially diagnosed with relapsing-remitting multiple sclerosis. It takes a varying amount of time for it to develop into secondary progressive, and the risk increases with the duration of the patient's MS. For example, according to statistics, after 10 years of RRMS, the secondary progressive form develops in up to 50% of patients, and after 25 years from the onset, the transformation of the relapsing-remitting form into a secondary progressive form may occur in up to 90% of patients. In secondary progressive multiple sclerosis, the symptoms that arise from a relapse do not reverse. In patients with this type of disease, the symptoms of multiple sclerosis persist and gradually worsen, and the patient's condition usually deteriorates slowly but gradually.
Types of MS: Primary Progressive
About 10-15% of MS patients are diagnosed with primary progressive multiple sclerosis (PPSM, fromprimary progressive multiple sclerosis ). In this type of MS, neurological deficits exist from the beginning of the disease and the symptoms of multiple sclerosis gradually worsen. Patients may experience temporary periods of stabilization of their condition, however, in PPSM there are no typical remissions.
Types of MS: primary progressive with exacerbations
Multiple sclerosis primarily progressive with exacerbations is now a rather debatable type of MS - some authors are not at all inclined to single out this form of the disease. Its course is similar to the PPSM described above, however, there are noticeable exacerbations, which can be treated as MS relapses.
Types of MS: atypical forms of the disease
Two new types of the disease were added to the original classification, which distinguished the four types of MS described above. The first was the clinically isolated syndrome (CIS fromclinically isolated syndrome ). CIS is considered to be the so-called pre-morbid condition for multiple sclerosis and is diagnosed when symptoms that may correspond to multiple sclerosis have been present in the patient for a minimum of 24 hours and the patient has noticeable abnormalities in imaging tests, and at the same time the criteria for the diagnosis of multiple sclerosis are not yet met. Not all patients who develop CIS later develop full-blown multiple sclerosis. According to statistics, 30 to 70% of people with CIS develop MS in the future. In addition to CIS, RIS, i.e.radiology isolated syndrome , has also been introduced into the classification. This problem is recognized in those patients who have imaging abnormalities that may correspond to MS, and who at the same time do not have any symptoms typical of the disease. Some authors distinguish other disorders that could be treated as problems with the sclerosis spectrum. scattered. The classification controversies arise here from the fact that, according to other researchers, these problems may not constitute subtypes of multiple sclerosis, but actually separate disease entities. The above applies to states such as:
- Marburg variety (acute progressive MS, in which symptoms can increase even within days and lead to, among others, tetraplegia, and even death caused by e.g. respiratory disorders),
- Schilder disease (also a severe and rapidly progressive form of MS, it is observed in the pediatric population),
- pseudotumor multiple sclerosis (its first symptom may be a large demyelinating site in the brain, suggesting a tumor of the central nervous system),
- Balo concentric multiple.
Types of MS: why are they distinguished?
Differentiating the different types of multiple sclerosis is important mainly because the different types of this disease have a variable response of patients totreatment. The best results of therapy are obtained in patients with relapsing-remitting and secondary progressive multiple sclerosis, and worse results are observed in patients with primary progressive multiple sclerosis.
Time matters in MS treatment
About the importance of rapid implementation of appropriate therapy in the treatment of multiple sclerosis, says Magdalena Fac-Skhirtladze, Secretary General of PTSR. The statement was recorded during the scientific conference "Physiotherapy for he alth".