Types of MS

CIS (Clinically Isolated Symptom)

CIS (Clinically Isolated Symptom)

CIS (Clinically Isolated Symptom)

This is what we call when a person has an episode, which by definition must last for at least 24 hours, that effects the body in a way never felt before.   

Symptoms of CIS are similar to those of an MS relapse. The main difference between the two conditions is patients with CIS experience only one episode, while MS patients experience multiple episodes.

Symptoms of CIS include:

  • Numbness or tingling
  • Vision problems, such as double vision
  • Spasticity or stiffness of the muscles
  • Difficulty controlling the bladder or bowels
  • Difficulty with walking and coordination
  • Muscle weakness
  • Paralysis
  • Dizziness
  • Shakiness
  • Sexual dysfunction

Causes/Risks Factors

  • Patients with CIS tend to be diagnosed between the ages of 20 and 40, but the condition can occur at any age.
  • Since the risk of MS is significantly higher when a parent has been diagnosed with the disease, genetic factors may play a role.
  • The unusual relationship between a person's geographic location during childhood and the risk of MS later in life suggests there may be environmental factors at work in the the risk of CIS or MS. 

CIS is a characteristic of multiple sclerosis but does not yet meet the criteria for a diagnosis of MS because people who experience a CIS may or may not go on to develop MS. *


Relapsing Remitting MS

CIS (Clinically Isolated Symptom)

CIS (Clinically Isolated Symptom)

Relapsing Remitting Multiple Sclerosis – the most common disease course – is characterized as an active form of MS with clearly defined attacks of new or increasing central nervous symptoms. These attacks – also called relapses or exacerbation – are followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent. However, there is no apparent progression of the disease during the periods of remission.

At different points in time, Relapsing Remitting Multiple Sclerosis can be further characterized as either active (with relapses and/or evidence of new MRI activity) or not active, as well as worsening (a confirmed increase in disability over a specified period of time following a relapse) or not worsening. An increase in disability is confirmed when the person exhibits the same level of disability at the next scheduled neurological evaluation, typically 6 to 12 months later.

Approximately 85 percent of people with MS are initially diagnosed with RRMS. 


Symptoms of RRMS:

The most common symptoms reported in RRMS include episodic bouts of fatigue, numbness, vision problems, spasticity or stiffness, bowel and bladder problems, and problems with cognition (learning and memory or information processing). People with progressive forms of MS are more likely to experience gradually worsening problems with walking and mobility, along with whatever other symptoms they may have.

 Relapsing Remitting Multiple Sclerosis is defined by inflammatory attacks on myelin (the layers of insulating membranes surrounding nerve fibers in the central nervous system (CNS)), as well as the nerve fibers themselves. During these inflammatory attacks, activated immune cells cause small, localized areas of damage which produce the symptoms of MS. Because the location of the damage is so variable, no two people have exactly the same symptoms. With this type, you have flare-ups of the disease, or relapses. Between these flare-ups, you have periods of recovery, or remissions.

Most people diagnosed with MS start off with the relapsing-remitting type. In most cases, the course of the disease changes after a few decades and is then likely to become steadily worse. *

* From NMSS.org 

Transitioning from RR to SPMS

CIS (Clinically Isolated Symptom)

Transitioning from RR to SPMS

 Most neurologists are are slow to classify Secondary Progressive Multiple Sclerosis during the time a patient is transitioning from RRMS to SPMS types of ms .  There is no clinical, biological or objective measure used to move a patient from Relapsing Remitting MS to Secondary Progressive MS.  The simple truth is different neurologists are using different measurements to diagnose the same condition.  

The general premise is that over time more and more RRMS patients will transition into SPMS patients. These patients will basically have two stages of the disease. The first stage is largely depicted by inflammation, with regular periods of relapses and remissions. During this inflammation stage, improvement during periods of remission is expected and often complete. Most MS drugs are more effective during this predominantly inflammatory stage. The increased use of disease-modifying therapies has also had an impact on the RRMS to SPMS transition. DMTs are proving to alter the natural history of MS and even delaying the onset of SPMS. The second stage is characterized by less inflammation, fewer flare ups, and a steady worsening of symptoms and disability. In this stage, any symptom improvement is generally incomplete to and may not even be apparent. Normally, first-line drug therapies are abandoned for second-line drugs such as Tysabri, Rituximab,  Ocrevus, Novantrone,  and Methotrexate. Some of the SPMS criteria used by neurologists include:

• EDSS/disability scale
• Medical history
• Relapse rate (especially the absence of relapses) 
• Incomplete remissions or symptom improvement
• Gradual increase in disability or symptoms
• MRI evidence - accumulation of black holes, brain atrophy, etc.
• Benfits of medication
• The length of time diagnosed
• Age of the patient
• Patient feedback (I don't ever seem to improve.)

 The longer a patient has been diagnosed with MS, the easier it becomes to diagnose SPMS. In some cases, a patient may move into the SPMS category before they were ever diagnosed with MS. 

Many Neurologists are reluctant to diagnose Secondary Progressive because some medications are only approved for Relapsing Remitting and the change in diagnosis would disqualify the patient from an effective medication. multiple sclerosis

Secondary Progressive MS

Secondary Progressive MS

Transitioning from RR to SPMS

SPMS follows an initial relapsing-remitting course. Most people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time.  There are two types of Secondary Progressive Multiple Sclerosis.  

Inactive SPMS: where medication to prevent attacks have no effect because the disease has quieted down, so treating for relapses is ineffective. 

Active SPMS which does respond to DMD's by preventing more damage from happening. It differs from RRMS in that we no longer recover. Keeping these attacks from occurring may help us prevent new and additional damage not typical to the classic SPMS which old damage just seems to get worse.  measure of change over time, with or without relapses) or without progression.  

Prior to the availability of the approved disease-modifying therapies, studies indicated that 50 percent of those diagnosed with relapsing-remitting MS (RRMS) would transition to secondary-progressive MS (SPMS) within 10 years, and 90 percent would transition within 25 years.

While MS experts agree that the medications have an impact on disease progression, it is too soon to tell the extent to which the disease-modifying treatment

 t differs from PPMS in that it is impossible for this type of MS to have a relapse when their disease is defined as a constant ongoing relapse. 

Primary Progressive MS

Secondary Progressive MS

Primary Progressive MS

15% are diagnosis are Primary Progressive MS initially.  

  • It is characterized by a steady worsening neurologic function (accumulation of disability) from the onset of symptoms, without remissions. *NMSS.org
  • The speed of disability progression can be very slow or fast.-  these symptoms tend to be more gradual as opposed to stroke-like periods of sudden exacerbations seen in active relapsing remitting multiple sclerosis.  



* Disclaimer: The information you find here in MS Frontiers Multiple Sclerosis Support is based on what has worked for some of us with MS. No one solution or medication works for everyone, so the suggestions and information you find on this site should not take the place of your doctor.