Multiple Sclerosis (MS)

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What is the Course of MS?

Each case of Multiple Sclerosis (MS) displays one of several patterns of presentation and subsequent course. Most commonly, Multiple Sclerosis (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 (RR) Multiple Sclerosis (MS). Primary-progressive (PP) Multiple Sclerosis (MS) is characterized by a gradual clinical decline with no distinct remissions, although there may be temporary plateaus or minor relief from symptoms. Secondary-progressive (SP) Multiple Sclerosis (MS) begins with a relapsing-remitting course followed by a later primary-progressive course. Rarely, patients may have a progressive-relapsing (PR) course in which the disease takes a progressive path punctuated by acute attacks. PP, SP, and PR are sometimes lumped together and called chronic (lasting a long time) progressive Multiple Sclerosis (MS).

In addition, twenty percent of the Multiple Sclerosis (MS) population has a benign form of the disease in which symptoms show little or no progression after the initial attack - these patients remain fully functional. A few patients experience malignant Multiple Sclerosis (MS), defined as a swift and relentless decline resulting in significant disability or even death shortly after disease onset. However, Multiple Sclerosis (MS) is very rarely fatal and most people with Multiple Sclerosis (MS) have a fairly normal life expectancy.

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 Multiple Sclerosis (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 Multiple Sclerosis (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.

References:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke (NINDS)
National Institutes of Health
January 23, 2008
www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm

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