Types of Multiple Sclerosis
It all begins with..., one day you're walking at home or work and then your leg gives out and you fall. You may have these strange spots in your eyes that never seem to go away even when you clean your glasses. Your arm feels like it has fallen asleep again, or you seem to be tired all of the time and can't get your energy back. It could be that your speech is slurred and you haven't had anything to drink in a week or two, or it's the middle of summer and you thought you were going to get that yard work done, instead you feel wiped out and have to rest. Then your arms and hands shake or tremor uncontrollably, or one of another hundred things could be happening. It's time for you to go see a doctor.

Then you see a doctor, and then a neurologist, and have some wonderful tests done to rule out some conditions and then to verify one. A magnetic resonance imaging (MRI) will reveal if there is any scarring and then a lumbar puncture or spinal tap will provide you with confirmation. You are then presented with multiple sclerosis (MS) and it's the answer, the reason, and the cause. What is this horrible thing and what's it doing to you? What will become of you and your future? Where will this thing take you and how bad will it get?

The two MRI's below show lesions on the brain and on the spinal cord. There are three distinct lesions on the left image of the brain and three distinct lesions on the spinal cord around the 2nd and 3rd cervical vertebra. There is a great significance to the lesions on the spinal cord in that the location is prior to any branching off. Lesions at this location can have a profound impact on multiple locations and possibly with greater severity. This could be compared to damage on a high voltage electrical wire and when it has problems, all of the smaller wires have problems.

Visible Lesions on MRI The brain MRI shows 3 large lesions and several smaller throught the area.
The cervical MRI shows 3 large lesions located at the C1, C2 & C3 vertebra.

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The four main types of MS

Relapsing-Remitting Multiple Sclerosis (RRMS)

Primary-Progressive Multiple Sclerosis (PPMS)

Secondary-Progressive Multiple Sclerosis (SPMS)

Progressive-Relapsing Multiple Sclerosis (PRMS)

How does MS progress or worsen? What are the stages of this disease? Where are you in all this? The type of MS or its clinical course is of great importance.

Each type is a worsening of the disease and when it reaches the next course, there is no turning back. That's why early detection and diagnosis is so important. When a doctor suspects that the symptoms could possibly be MS, they try to rule out anything else but it can only confirmed through an MRI and spinal tap. An MRI of the brain and spinal cord will show any lesions or scars existing or in an active state. A spinal tap will give them further confirmation of the disease when the spinal fluid is tested. Now they can proceed to the next step.

image info This image is Copyright © My-MS.org and falls under Image License D defined under the Image License section of the Disclaimer page.

Prior to the mid-1990's, when someone was diagnosed with MS, it was generally felt that there was not much that could be done to keep it at bay. Once the current medications were approved and the results looked so good, doctors began to place patients on the medications as soon as they were diagnosed. As with any illness, early treatment is the key to slowing down the progression. Unfortunately, slowing it down is the best option at the current time. Every step, with every drug, brings us that much closer to a time when MS can be stopped, reversed, or even cured.

Since MS is a chronic disease, progression will most likely occur. On the bright side, around 80% of those with MS have relapsing-remitting MS (RRMS). You can also have progression while staying within your current clinical course. When progression increases in frequency, duration, severity, etc..., your clinical course may change.

You can have an impact on how strong or rapid your progression is by just remembering all those bits of advise from your doctors and even your parents - exercise daily, proper nutrition, don't stay up too late, get plenty of sleep, and the list goes on and on. It all boils down to taking care of yourself, your body and your mind. The other benefit of this bit of advice would possibly be a lowering of your cholesterol, a healthier heart, greater strength, and possibly an improvement of your symptoms.

Each of the four clinical courses can range from mild, moderate, or severe. It's all, however, just a degree of the same thing, you have MS. It's kind of like being pregnant, either you are or you aren't, how far along is the only variable.

Now either you have MS and you must take it very seriously or you don't. Just because you might have a mild case of RRMS doesn't mean that you don't have to treat it. No matter which severity of the clinical courses you may have, they all must be taken very seriously, for if you don't, it may just cost you a price that is more than you wish to pay.

It's important to know that you can no longer afford to burn the candle at both ends. It's important that you make that candle last as long as you can, because it's your only one and can't be replaced. You don't have to stop what you do, but rather become careful with your choices and mindful of the consequences. Just like when you are in your 40's or 50's, you can't act as if you are 18 again, whether or not you have MS. You can, however, still have a good time and enjoy life.
Three not so common courses of MS

Chronic-Progressive MS (CPMS)

Malignant MS

Benign MS

Chronic-progressive MS (CPMS) and malignant MS both are not welcome. They both are running a course that is leading to greater and nearly constant attacks. You aren't given much if any rest between the battles upon yourself. These, however, aren't very common, but one person with one of these is too many. These two would usually fall in the severe progressive-relapsing MS (PRMS) clinical course from above.

Now what anyone with MS would hope for, other than a cure, would be to have benign MS since it gives you a glimpse of its strength and the chance to take it seriously. This usually makes and appearance with an exacerbation and never shows up again. To have one attack and possibly not to have anymore, that's something to dream about. This would usually fall in the mild RRMS clinical course from above.
Pediatric MS
Although MS occurs most commonly in adults, it’s also diagnosed in children and adolescents. Estimates suggest that 8,000 to 10,000 children (those 18 years of age or less) in the U.S. have MS, and another 10,000 to 15,000 have experienced at least one symptom suggestive of MS.

MS historically has been viewed as an adult-onset disease and the majority of research and support programs have targeted adults. Since 1980, however, over 400 cases of childhood MS have been recorded in over 25 medical publications. Initial symptoms have been seen as early as 13 months old, with diagnosis as young as 2 years of age. Largely because of new technology, the numbers of children and adolescents diagnosed with MS are steadily growing.

Studies have shown that 2 to 5% of all people with MS have a history of symptoms onset prior to the age 18. Diagnosis in children is more challenging than in adults due to the frequency of other childhood disorders with similar symptoms and characteristics.

For children, the first signs of the disease are typically different. A child may have a nerve disorder called acute disseminated encephalomyelitis (ADEM). The typical symptoms of ADEM may include headache, confusion, coma, seizures, stiff neck, fever, and major lack of energy. After a few weeks, the symptoms of ADEM will usally lessen or go away. Some children, however, will keep having problems that are the same as MS.
Most symptoms of MS seen in children are similar to those seen in adults. There are, however, symptoms experienced by children that are not typical in adults, such as seizures and mental status changes.

Increasing evidence suggests a slower disease course in children with MS, but significant disability can accumulate at an earlier age compared to individuals with adult onset MS. Psychosocial consequences of MS in children and adolescents may affect academic performance, family relations, and specific adolescent issues including self-image and relationships with peers. An evaluation by a trained professional can help determine appropriate interventions. Pediatricians may not be familiar with MS because they are not expecting to see it in children.

As the leading private funder of MS research, and because of the critical need to better understand childhood MS, the National MS Society established the first-of-its kind network of Pediatric MS Centers of Excellence. The centers were established in geographically diverse areas so that they can serve as regional centers for as many children and families living with MS as possible. They are staffed by teams of pediatric and adult MS experts who lead the field in MS diagnosis and treatment. The Center locations are:
Center for Pediatric-Onset Demyelinating Disease at the Children's Hospital of Alabama, University of Alabama at Birmingham
Pediatric MS Center of the Jacobs Neurological Institute, State University of New York at Buffalo
Mayo Clinic T. Denny Sanford Pediatric Outpatient Center, Rochester, MN
National Pediatric MS Center at Stony Brook University Hospital, Long Island
Partners Pediatric MS Center at the Massachusetts General Hospital for Children in Boston
University of California, San Francisco Regional Pediatric MS Center