clinical subtypes of Multiple Sclerosis (MS)

Q: What are the three clinical subtypes of Multiple Sclerosis (MS) in adult patients?

Answer: MS is largely categorized into three clinical subtypes depending on behavior over the years, such as flares/exacerbations with full or incomplete recovery, fever, time period, progression, disability, plateaus, temporary minor improvements, and/or superimposed acute relapses.

1. Relapsing-remitting multiple sclerosis (RRMS)

2. Secondary progressive multiple sclerosis (SPMS)

3. Primary progressive multiple sclerosis (PPMS)

RRMS is defined as relapses with either full recovery or with sequelae and residual deficit upon recovery. There is no or minimal disease progression during the periods between disease relapses, though individual relapses themselves may occasionally result in severe residual disability.

SPMS evolves from RRMS; hence, the word "secondary" is used, as over time, the disease enters a stage of steady deterioration in function, with or without superimposed attacks. The relapse rate is typically reduced when the secondary progressive stage is reached. This may be a phenomenon of immunosenescence, as relapses and new MS lesions are less common as people age.

PPMS represents approximately 10 percent of MS cases and is characterized by disease progression from onset, although occasional plateaus, temporary minor improvements, and acute relapses may occur.

The treatment plans are differentiated depending on clinical subtypes.

Some authors mention a fourth type, as the name explains: clinically isolated syndrome (CIS)

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References:

1. Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017 Apr-Jun;19(1):1-10. doi: 10.22074/cellj.2016.4867. Epub 2016 Dec 21. PMID: 28367411; PMCID: PMC5241505.

2. Fujihara K. [Clinical subtypes of multiple sclerosis and the immuno-pathogeneses]. Nihon Rinsho. 2003 Aug;61(8):1293-9. Japanese. PMID: 12962014.