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4 Types of Multiple Sclerosis

What is Multiple Sclerosis?

Multiple sclerosis (MS) is known to be an autoimmune disease that causes inflammation throughout the body and also affects the peripheral nerves and the central nervous system.

The exact cause of Multiple sclerosis (MS) remains unknowns, but there have been many studies that have indicated that there is a possible link between MS and the Epstein Barr Virus.(1) Other studies have also indicated that environmental factors combined with a lack of vitamin D, or parasites act as a stimulant of the body’s immune response in the central nervous system, causing the disease.(2) Nevertheless, the cause remains unknown.

Multiple sclerosis (MS) can be unpredictable and many times, disabling. However, not all types of MS are the same.

To distinguish between the different types of MS, the National Multiple Sclerosis Society (NMSS) has come up with four distinct categories of MS. Let’s take a look at these four types of Multiple sclerosis (MS).

4 Types of Multiple sclerosis (MS)

In 1996, the NMSS categorized MS into four different types after consultation with a group of scientists specializing in MS research and patient care.

The definitions of these four types of MS were again updated in 2013 in order to reflect the advances in MS research. These four types of MS include:

  1. Clinically isolated syndrome (CIS)
  2. Relapsing-remitting MS (RRMS)
  3. Primary-progressive MS (PPMS)
  4. Secondary-progressive MS (SPMS)

These four types of Multiple sclerosis (MS) are what doctors today use for diagnosing and treating MS. These four categories are also the classifications on determining the progression of the disease in each patient.

  1. Relapsing-Remitting MS (RRMS)

    RRMS is the most common type of Multiple sclerosis (MS) that affects people. According to statistics from the NMSS, nearly 85 percent of people who have MS have this type of MS at the time of their diagnosis. Some of the signs and symptoms you might experience when you have RRMS include:

    • Complete or partial remissions (recovery periods) after having relapses and also between attacks while the disease stops progressing.
    • Very well defined flare-ups (relapses) that lead to episodes of intensive worsening of your neurological functioning.
    • Mild to severe symptoms as well as remissions and relapses that can last for days or even months.
  2. Clinically Isolated Syndrome (CIS)

    CIS is a very common types of Multiple sclerosis (MS) that is observed. CIS refers to a single episode of neurological symptoms lasting for 24 hours or more. These symptoms are not usually tied to infection, fever, or any other illnesses. The symptoms are usually caused due to inflammation or demyelination occurring in the central nervous system.

    It is possible to only experience one symptom (known as a monofocal episode), or you can also experience multiple symptoms (referred to as multifocal episode).

    If you have CIS, then it might very well be that you never experience another episode again. Or it might also be that this if your very first MS attack.

    If brain lesions that are associated with Multiple sclerosis (MS) patients detected on an MRI test, then there is a 60 to 80 percent chance of you having another episode and arriving at a diagnosis of MS in a couple of years.(3)

    At this point, you might also get a diagnosis of Multiple sclerosis (MS) if the MRI detects older lesions present on another part of the central nervous system. This means that you have had a previous attack, but were probably not aware of it.

    You might also be diagnosed with MS if your doctor finds cerebrospinal fluid containing oligoclonal bands.

  3. Primary-progressive MS (PPMS)

    The majority of people who have Multiple sclerosis (MS) are usually diagnosed with the RRMS form of the disease. Some patients, though, are diagnosed with a progressive form of MS. This is of two types – primary progressive MS and secondary progressive MS. Both these types of MS continue to progress and worsen without any improvement.
    In primary progressive MS (PPMS), the disease progresses slowly, but steadily, right from the time of onset. The symptoms of the disease also remain at the same level of intensity and do not decrease or increase. The patient does not experience any remission periods in between. Overall, patients who have PPMS continue to experience a steady worsening of their condition.

    There can be some variations in this rate of progression of Multiple sclerosis (MS) throughout the disease, and there is also the possibility of some patients experiencing minor improvements which are generally temporary. At the same time, they can also experience occasional plateaus in the progression of their symptoms.

    Statistics from the NMSS suggests that nearly 15 percent of MS patients have PPMS from the onset of the disease.(4)

  4. Secondary-Progressive MS (SPMS)

    This type of Multiple sclerosis (MS) is thought to be a mixed bag. The disease involves a time period where you experience relapsing and remitting activity combined with flare-ups of symptoms and then followed by recovery. Nevertheless, the disability of MS remains present between all the cycles.

    This period of fluctuation is typically followed by a rapid and steady worsening of the patient’s condition. Patients who are diagnosed with SPMS are likely to experience periods of minor remissions or relief from their symptoms, but this is not the case in all patients.

    Without treatment, though, almost half of the patients who have RRMS will go on to progress onto SPMS within a decade.


It is difficult and challenging for doctors to diagnose Multiple sclerosis (MS) in the early stages. This is why it is helpful to understand the typical characteristics and symptoms of the disease in the initial stages, especially because of the wide majority of patients who have Multiple sclerosis (MS) exhibit the symptoms of RRMS.

While there is no cure for MS, it is not fatal, and the symptoms can be managed for a fairly long time with treatment. Most people who have MS also never end up becoming completely disabled.

Diagnosing MS early during the relapsing remitting stage itself can help doctors provide prompt treatment to slow down the progression of the disease into the more aggressive forms.


  1. Veroni, C., Marnetto, F., Granieri, L., Bertolotto, A., Ballerini, C., Repice, A.M., Schirru, L., Coghe, G., Cocco, E., Anastasiadou, E. and Puopolo, M., 2015. Immune and Epstein-Barr virus gene expression in cerebrospinal fluid and peripheral blood mononuclear cells from patients with relapsing-remitting multiple sclerosis. Journal of neuroinflammation, 12(1), p.132.
  2. Correale, J. and Gaitan, M.I., 2015. Multiple sclerosis and environmental factors: the role of vitamin D, parasites, and Epstein–Barr virus infection. Acta Neurologica Scandinavica, 132, pp.46-55.
  3. National Multiple Sclerosis Society. (2019). Clinically Isolated Syndrome (CIS). [online] Available at: https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Clinically-Isolated-Syndrome-(CIS) [Accessed 4 Jul. 2019].
  4. National Multiple Sclerosis Society. (2019). MS the Disease. [online] Available at: http://www.nationalmssociety.org/press-room/ms-the-disease/index.aspx [Accessed 4 Jul. 2019].

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Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 3, 2022

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