MS is a complex condition for doctors to predict, as its symptoms and progression differ for everyone. There are four main types, along with some other rare MS types.
This chronic nerve condition affects long threadlike parts of the nerve cells (axons) protected by nerve coating, called myelin, in the central nervous system (CNS). In this condition, damage to the myelin (demyelination) occurs as the disease progresses. Doctors cannot yet repair the damaged myelin. How the disease progresses may determine how often or severe the symptoms are.
Healthcare professionals name the four main types of MS depending on how the disease progresses, with two more severe and rare MS types described by their main characteristics.
MS types
The four main types of MS are:
- clinically isolated syndrome (CIS)
- relapsing-remitting
- secondary progressive
- primary progressive
Clinically isolated syndrome
CIS refers to the first time you experience symptoms related to the nerves that are common in MS. Doctors will usually diagnose CIS if symptoms last for a minimum of 24 hours and there is evidence of brain inflammation and loss of myelin.
Doctors use a series of tests to determine the risk of CIS developing into MS. The tests include MRI scans to look for brain or spinal lesions and cerebrospinal fluid (CSF) testing to look for inflammation.
According to the MS Society, if MRI scans reveal specific types of brain or spinal lesions commonly seen in people with MS, your chances of developing in the coming years are around 60–85%. If your scan does not reveal these lesions, your risk of MS development reduces to 20%.
Treatment for CIS may include disease-modifying drugs (DMDs), as these may help to prevent future episodes and delay MS onset.
Relapsing-remitting MS (RRMS)
Most people who received a diagnosis of MS recently are told they have RRMS. In this case, doctors and healthcare professionals will track the disease’s progress.
People with RRMS usually experience attacks or relapses of severe symptom flare-ups. They return to their usual ability level after that. Though after a relapse, the ability to return to their usual self decreases with time.
The time between relapses can be weeks, months, or years, as people often take DMDs to prolong this time.
Stem cell therapy is showing promise as an MS treatment. But the Food and Drug Administration (FDA) has not yet approved it. Doctors may still consider stem cell therapy when high efficacy DMDs have not helped manage the condition in younger people with RRMS or active MS or have a shorter disease duration
Secondary progressive MS (SPMS)
If you have a history of RRMS relapses, you may go on to develop SPMS. Usually, this will display as a slow but gradual worsening in your neurological health, and it can occur with or without occasional relapses. Those with severe cases of untreated RRMS usually receive an SPMS diagnosis.
Primary progressive MS (PPMS)
PPMS is less common, and healthcare professionals define it as a type of MS that displays progressively declining symptoms right from the start with no apparent relapses. Though people with PPMS can sometimes get relief from symptoms, it may be only minor or temporary.
Ocrelizumab (Ocrevus) is currently the only drug the FDA has approved for treating PPMS.
Progressive relapsing MS (PRMS)
Doctors and healthcare professionals may most recently refer to PRMS as primary progressive MS. PRMS may be considered active or not active. PRMS is the least common MS type that displays worsening neurological symptoms from the start, with some relapses experienced to an intense degree (acute).
Treatments may include drugs like corticosteroids prescribed to reduce symptom severity and lessen the recovery time during a relapse.
Treatments
In the United States, if the FDA approves a DMD for RRMS, doctors can also prescribe it for active SPMS.
The table below shows some treatment options arranged by how you would take them.
| Injection | Oral | Infusion |
|---|---|---|
| glatiramer acetate (Capoxone) | dimethyl fumarate (Tecfidera) | natalizumab (Tysabri) |
| interferon beta-1a (Avonex, Refib) | fingolimod (Gilenya) | ocrelizumab (Ocrevus) |
| peginterferon beta-1a (Plegridy) | teriflunomide (Aubagio) | alemtuzumab (Lemtrada) |
| interferon beta-1b (Betaseron or Extavia) | monomethyl fumarate (Bafiertam) | |
| cladribine (Mavenclad) | ||
| siponimod (Mayzent) |
Rare MS types
There are also some rare MS types to know about.
Marburg variant
This type of MS is very rare, so experts do not yet have a complete overview of its characteristics. With the Marburg variant, symptoms and damage progress quickly. This may lead to severe physical limitations or death within a few weeks or months. Often, a brain biopsy is necessary for diagnosis.
This condition does not often respond well to treatment. Because it is so rare, there are very few case studies. In a 2021 case report, a 31-year-old female displayed complete remission following biopsy and early mitoxantrone (MITX) treatment.
Baló concentric sclerosis (BCS)
Experts often describe this inflammatory CNS disease in connection with MS. It is a demyelinating (damaged myelin) disease that can also be fast-progressing and appears on MRI scans as alternating, or concentric, rings in the brain.
A 2021 clinical review of 40 cases over a 21-year period mentions that most patients received initial corticosteroid treatment, but more than half also needed further therapy. However, in more recent studies, 83% of participants with Baló-like lesions showed clinical improvement or full recovery.
Corticosteroids may help reduce the severity of symptoms experienced to a severe degree (acute).
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Get free cardMS symptoms
Initial MS symptoms are often different for everyone, but some early signs can include the following:
- visual disturbances, like blurred vision or optic neuritis
- bladder weakness or difficulty in emptying the bladder
- dizziness, loss of balance, or being clumsy
- tingling sensations or numbness in the face, arms, hands, trunk, legs, or feet
- weakness in hands and legs, painful muscle spasms, and stiffness
As the condition progresses, or during a relapse, you may also notice some other symptoms, including:
- cognitive difficulties, such as difficulty concentrating, memory recall, thinking, and learning
- difficulties with decision making and judgment
- fatigue, physical or mental
- experiencing difficulty in managing emotions or feeling depressed
Making sense of MS
Receiving an MS diagnosis can be an overwhelming experience. There are many different symptoms to navigate, with the possibility of some life changing limitations. However, help and support are always available.
Our beginner’s guide to MS may help you understand some of the complexities of the condition.
Resources and educational materials are available through the National MS Society, with a wide range of peer support groups. Alternatively, you can call the National MS Society at 800-344-4867.
Summary
There are four main types of MS and two less common or rare types.
The main types are CIS, RRMS, SPMS, and PPMS. The less common and rare types are BCS and the Marburg variant.
A wealth of information and support is available online, in person, and over the phone, as it is important to look after both your physical and mental health after receiving an MS diagnosis.
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