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Development of the Categories of MS
In 1996 an international panel worked to make the diagnosis of Multiple Sclerosis more relevant to the patients with it and the doctors treating it. By this time the first of the Disease Modifying Therapies were in use and more were being studied. Coming up with the diagnosis was clearer, but what doctors really needed to know was who would benefit - or not - from these new medications.
The results were published in 1996 and the two main authors were Lublin, F, MD and Reingold, S., MD. They described the four categories of multiple sclerosis we use today.
RELAPSING REMITTING MS (RRMS) - 85% of people fall into this category at the onset of their disease
*** A Relapse is defined as an appearance of new symptoms or a worsening of old symptoms. It may be a combination of old and new symptoms. It must occur in the absence of fever and last at least 48 hours. It is not associated with the withdrawal of steroids (some people’s symptoms are quieted by steroids only to rebound back and worse when the steroids are stopped). The Relapse must be preceded by a period of clinical stability lasting at least a month. (Clinical stability means the symptoms were either stable or not worsening)
*** In RRMS relapses occur with full or partial recovery and there is disease/symptom stability between attacks.
SECONDARY PROGRESSIVE MS (SPMS) - 50% of people with RRMS will convert to SPMS over time.
*** This form begins with Relapsing Remitting MS, but after time there is no period of stability between relapses.
*** May still have relapses, but symptoms will get worse or progress between relapses.
PRIMARY PROGRESSIVE MS (PPMS) - 15% of people with MS will have this form
*** Symptoms of MS begin gradually and slowly worsen over time. The appearance of problems may be insidious, barely noticed by the patient. Worsening must be progressive for more than one year. This type is more difficult to tell apart from other neurologic degenerative diseases.
*** There may be some stable periods.
*** Often difficult to diagnose. Brain lesions may appear smaller and fewer, but brain atrophy (shrinking of the brain) is seen earlier. Many sources state the the primary disabling disease lies in the spinal cord. It appears that there is less inflammation and there is more and earlier axonal death. The spinal tap is more likely to be negative. Some researchers believe that Primary Progressive may be a different disease than RRMS.
PROGRESSIVE RELAPSING MS (PRMS) - Occurs in 5% of people with MS, or one third of those with Primary Progressive MS will convert into PRMS.
*** Primary Progressive onset followed by one or more relapses later in disease. The disease begins with a progressive loss of function and accumulation of symptoms, but later there are typical relapses superimposed.