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What is the Course of MS?
I (the webmaster) believe or should I say feel I know the course of Multiple Sclerosis is different form person to person just like the
symptoms are different from person to person. Now on to articles from the above websites.
The course of MS results from the interplay of two clinical processes, relapses and progression.
Each case of MS displays one of several patterns of presentation and subsequent course. Most commonly, MS first
manifests itself as a series of attacks followed by complete or partial remissions as
symptoms mysteriously lessen, only to return
later after a period of stability. This is called
relapsing remitting multiple sclerosis (RRMS).
Secondary Progressive Multiple Sclerosis (SPMS) begins with a relapsing-remitting
course followed by a later
primary-progressive (PPMS) course. Primary-progressive is
characterized by a gradual clinical decline with no distinct remissions, although there may be temporary plateaus
or minor relief from symptoms. Rarely, patients may have a progressive-relapsing (PRMS) course in which the disease
takes a progressive path punctuated by acute attacks. PPMS, SPMS, and PRMS are sometimes lumped together and
called chronic progressive MS.
The disease appears on average at the age of 30. It has been diagnosed
earlier and later. MS follows a
Remitting or a Progressive course in 85% and 15% of the cases,
respectively.
Initial symptoms are related to an isolated or combined disturbance(s)
of the long tracts of the
Central Nervous System, of the
Brain Stem, or of
the
Optic Nerve in 70%, 20% and 25% of the cases, respectively.
The relapse rate is one relapse on average every other year. After an
Exacerbating/Remitting onset of MS, secondary progression appears after
10-20 years on average.
The median time to reach the landmarks of irreversible disability are
8 years regarding limitation of ambulation, 20 years for walking with a
stick, and 30 years for wheel-chair dependency.
In fact, MS prognosis is highly variable depending on individuals. All
the intermediate types do exist between malignant forms, possibly lethal,
and
Benign forms (circa 30% of the cases) that allow normal daily life.
The clinical and para clinical predictive factors identified so far
have been acknowledged statistically. They provide little help however, if
any, when an individual is concerned.
Recent research has showed that relapses have only a marginal effect,
relatively to progression, on the accumulation of irreversible
Neurological disability.
Furthermore, the age when reaching the landmarks of irreversible
disability is essentially similar whatever the mode of onset of MS, be it
Exacerbating/Remitting or Progressive.
In spite of the outstanding clinical polymorphism of MS, a unifying
concept of the disease ("complexity vs. heterogeneity") can be put
forward.
People with MS can typically experience one of Five disease courses,
each of which might be mild, moderate, or severe.
Studies
throughout the world are causing investigators to redefine the
natural course of the disease. These studies use a technique
called Magnetic resonance imaging
(MRI) to visualize
the evolution of MS lesions in the white matter of the brain.
Bright spots on a T2 MRI scan indicate the presence of
lesions, but do not provide information about when they
developed.
Because
investigators speculate that the breakdown of the blood/brain
barrier is the first step in the development of MS lesions, it
is important to distinguish new lesions from old. To do this,
physicians give patients injections of gadolinium, a
chemical contrast agent that normally does not cross the
blood/brain barrier, before performing a scan. On this type of
scan, called T1, the appearance of bright areas indicates
periods of recent disease activity (when gadolinium is able to
cross the barrier). The ability to estimate the age of lesions
through MRI has allowed investigators to show that, in some
patients, lesions occur frequently throughout the course of
the disease even when no symptoms are present.
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