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What to Expect At Various Stages of Multiple Sclerosis?

Multiple sclerosis is a progressive disease in which the body’s immune system attacks the central nervous system. This disease tends to present differently in different people, and no two people are known to have the same symptoms of multiple sclerosis. Once the immune system starts to attack the protective covering of the nerves, known as myelin, it results in nerve damage over a period of time. This disrupts the communication that takes place between the brain and the body. There are four main types of multiple sclerosis, which have different symptoms, different stages, and their progression pathways are also different. Read on to find out about what to expect at various stages of multiple sclerosis.

What is Multiple Sclerosis?

Multiple sclerosis is a chronic and progressive disease that impacts the central nervous system, particularly the spinal cord, brain, and optic nerves.(1,2) This causes a wide range of symptoms throughout the body. In multiple sclerosis, the body’s immune system itself turns on itself and starts attacking the protective covering of the nerves known as myelin. Over time, this covering gets damaged so badly that it leads to nerve damage. While some people experience mild symptoms such as numbness, blurred vision, tingling in the extremities, others may experience more severe symptoms such as vision loss, paralysis, and mobility issues.(3,4) Fatigue is also a prominent symptom of multiple sclerosis.(5)

According to statistics of the National Institute for Neurological Disorders and Stroke (NINDS), around 250,000 to 350,000 people in the United States alone are living with multiple sclerosis.(6) However, data from the National Multiple Sclerosis Society puts this number closer to one million.(7)

What to Expect At Various Stages of Multiple Sclerosis?

Understanding the progression of multiple sclerosis and knowing what to expect at each stage of the disease can help you get a sense of control over what is happening in your life and also help you make better decisions together with your doctor. Most people with multiple sclerosis are known to follow one of the four courses that the disease takes. These vary in severity and also from person to person.

Stage 1 of MS: Identifying the Symptoms

The first stage of the disease occurs even before your doctor makes an official diagnosis of multiple sclerosis. In this early stage, you start experiencing certain symptoms from time to time that starts to raise red flags.

Environmental and genetic factors are believed to have a role in who gets multiple sclerosis. If there is a family history of multiple sclerosis and you are worried about the risk of developing the disease, then all the more you will be on the lookout for the smallest sign of the disease.(8)

It could also be that you have been experiencing the symptoms of multiple sclerosis already, and your doctor has already warned you that this could be indicative of such an illness. Some of the common symptoms of MS include:

  • Fatigue
  • Tingling and numbness
  • Weakness
  • Dizziness
  • Pain
  • Cognitive changes
  • Vertigo
  • Walking difficulties

At this point, your doctor is able to determine whether you are at an increased risk for developing multiple sclerosis by looking at your medical history, family history, and performing a thorough physical examination.

However, as of today, there is still no definitive diagnostic test that confirms the diagnosis of multiple sclerosis. Furthermore, many of the symptoms are known to occur in other conditions as well, making the disease tough to diagnose.(9)

Stage 2 of MS: New Diagnosis

The next stage that people face is receiving a confirmed diagnosis of multiple sclerosis. Your doctor will diagnose you with the disease when there is ample evidence to show that at two different points in time, you have experienced separate episodes of disease activity in your central nervous system.(10)

It usually takes time to make a confirmed diagnosis of multiple sclerosis because your doctor needs to first rule out other conditions that also cause similar symptoms. These include genetic disorders, several autoimmune disorders, inflammatory disorders of the central nervous system, and infections of the central nervous system.(11)

In this stage of getting a new diagnosis, you can expect to discuss your potential treatment options with your doctor and also learn about new ways of how to manage your daily activities with the disease.

Of course, there are different types, and stages of multiple sclerosis and management or treatment of your condition also depend on how severe your symptoms are.(12)

Stage 3: Clinically Isolated Syndrome (CIS)

This stage of multiple sclerosis is marked by an experience of the first episode of symptoms. These symptoms are typically caused by inflammation and damage to the myelin sheath that covers the nerves present in the spinal cord or brain.(13) Technically, though, the stage of clinically isolated syndrome does not really meet the criteria for giving a diagnosis of multiple sclerosis because having only one incident with only one particular region of demyelination responsible for the symptoms is not sufficient to confirm multiple sclerosis.

However, if an MRI indicates that you have experienced another episode in the past, then a diagnosis of multiple sclerosis can be made at this stage as well.(14)

Stage 4 of MS: Relapsing-Remitting Multiple Sclerosis (RRMS)

The fourth stage is relapsing-remitting type of multiple sclerosis, which is known to follow a somewhat predictable pattern. You can expect to experience episodes in which the symptoms tend to get worse, and then improve. From here onwards, it is likely to progress to secondary progressive multiple sclerosis.(15)

According to data from the National Multiple Sclerosis Society (NMSS), nearly 85 percent of people with multiple sclerosis are initially diagnosed with relapsing-remitting multiple sclerosis.(16)

People who are at this stage of the disease, have flare-ups of relapses of multiple sclerosis. Between these relapses, they may experience periods of remission. However, over the years, the condition is likely to progress and change to become more complex and challenging to manage.

Stage 5 of MS: Secondary Progressive Multiple Sclerosis (SPMS)

Stage four relapsing-remitting multiple sclerosis is known to progress into secondary progressive multiple sclerosis, which is a more aggressive form of the disease. As per recommendations of the National Multiple Sclerosis Society, if you leave multiple sclerosis untreated, then half of the people with relapsing-remitting stage of the disease go on to develop secondary progressive multiple sclerosis within ten years of receiving the first diagnosis.(17)

Stage 6 of MS: Primary Progressive Multiple Sclerosis (PPMS)

Nearly 15% of people are diagnosed with primary progressive multiple sclerosis, which is a rare form of the disease.(18) This type of multiple sclerosis is marked by slow but steady disease progression with no remission periods in between. Some people with primary progressive multiple sclerosis may experience plateaus in their symptoms, but the improvements they experience are usually only temporary. The progression rate also varies over time.

Treating Multiple Sclerosis

While there is no cure for multiple sclerosis, there are several types of treatment options that are available for those diagnosed with multiple sclerosis.(19) Your doctor will work together with you to find the right combination of treatment to help you alleviate the symptoms and manage your condition to improve your quality of life.

Some of the over-the-counter treatments for managing some of the symptoms of multiple sclerosis include:

  • Stool softeners and laxatives, but these should not be used frequently
  • Pain relievers such as ibuprofen and aspirin

Prescription treatments may include:

  • Plasma exchanges for managing multiple sclerosis attacks
  • Corticosteroids to manage attacks
  • Physical therapy
  • Muscle relaxants
  • Dimethyl fumarate (brand name: Tecfidera)
  • Teriflunomide (brand name: Aubagio)
  • Glatiramer (brand name: Copaxone)
  • Beta interferons

Some people also prefer to use certain alternative remedies in combination with their prescribed treatment. These include:

At the same time, you should incorporate certain lifestyle changes to ensure that your symptoms are more manageable and that your overall health does not suffer. These include:

  • Eating a healthy and well-balanced diet
  • Exercising regularly, including several stretching exercises to avoid numbness in the extremities
  • Lowering your stress levels

It is never recommended that you make any changes to your treatment plan without consulting your doctor. And do not start any natural remedies before informing your doctor as these may also interfere with your current treatments or medications.


Being educated and aware of what to expect in each stage of multiple sclerosis can help you take better control of your condition and manage your symptoms. This also makes it possible to seek the appropriate treatment as required. Even though there is no cure for multiple sclerosis, researchers continue to make new strides and advances to improve their understanding of the disease. Working closely with your doctor can make it easier to manage multiple sclerosis and improve the overall quality of life.


  1. Dendrou, C.A., Fugger, L. and Friese, M.A., 2015. Immunopathology of multiple sclerosis. Nature Reviews Immunology, 15(9), pp.545-558.
  2. Sospedra, M. and Martin, R., 2005. Immunology of multiple sclerosis. Annu. Rev. Immunol., 23, pp.683-747.
  3. Trapp, B.D., Peterson, J., Ransohoff, R.M., Rudick, R., Mörk, S. and Bö, L., 1998. Axonal transection in the lesions of multiple sclerosis. New England Journal of Medicine, 338(5), pp.278-285.
  4. Ferguson, B., Matyszak, M.K., Esiri, M.M. and Perry, V.H., 1997. Axonal damage in acute multiple sclerosis lesions. Brain: a journal of neurology, 120(3), pp.393-399.
  5. Krupp, L.B., Alvarez, L.A., LaRocca, N.G. and Scheinberg, L.C., 1988. Fatigue in multiple sclerosis. Archives of neurology, 45(4), pp.435-437.
  6. Ninds.nih.gov. 2020. Multiple Sclerosis: Hope Through Research | National Institute Of Neurological Disorders And Stroke. [online] Available at: <https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Multiple-Sclerosis-Hope-Through-Research> [Accessed 31 July 2020].
  7. National Multiple Sclerosis Society. 2020. Who Gets MS?. [online] Available at: <https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS> [Accessed 31 July 2020]. Milo, R. and Kahana, E., 2010. Multiple sclerosis: geoepidemiology, genetics and the environment. Autoimmunity reviews, 9(5), pp.A387-A394.
  8. Rolak, L.A. and Fleming, J.O., 2007. The differential diagnosis of multiple sclerosis. The neurologist, 13(2), pp.57-72.
  9. Triulzi, F. and Scotti, G., 1998. Differential diagnosis of multiple sclerosis: contribution of magnetic resonance techniques. Journal of Neurology, Neurosurgery, and Psychiatry, 64, pp.S6-14.
  10. Herndon, R.M., 2006. Multiple sclerosis mimics. ADVANCES IN NEUROLOGY-NEW YORK-RAVEN PRESS-, 98, p.161.
  11. Calabresi, P.A., 2004. Diagnosis and management of multiple sclerosis. American family physician, 70(10), pp.1935-1944.
  12. D’Alessandro, R., Vignatelli, L., Lugaresi, A., Baldin, E., Granella, F., Tola, M.R., Malagu, S., Motti, L., Neri, W., Galeotti, M. and Santangelo, M., 2013. Risk of multiple sclerosis following clinically isolated syndrome: a 4-year prospective study. Journal of neurology, 260(6), pp.1583-1593.
  13. Filippi, M., Rocca, M.A., Ciccarelli, O., De Stefano, N., Evangelou, N., Kappos, L., Rovira, A., Sastre-Garriga, J., Tintorè, M., Frederiksen, J.L. and Gasperini, C., 2016. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. The Lancet Neurology, 15(3), pp.292-303.
  14. Prineas, J.W., Kwon, E.E., Cho, E.S., Sharer, L.R., Barnett, M.H., Oleszak, E.L., Hoffman, B. and Morgan, B.P., 2001. Immunopathology of secondary‐progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 50(5), pp.646-657.
  15. National Multiple Sclerosis Society. 2020. MS The Disease. [online] Available at: <http://www.nationalmssociety.org/press-room/ms-the-disease/index.aspx> [Accessed 31 July 2020].
  16. Thompson, A.J., Kermode, A.G., Wicks, D., MacManus, D.G., Kendall, B.E., Kingsley, D.P.E. and McDonald, W.I., 1991. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 29(1), pp.53-62.
  17. Miller, D.H. and Leary, S.M., 2007. Primary-progressive multiple sclerosis. The Lancet Neurology, 6(10), pp.903-912.
  18. Loma, I. and Heyman, R., 2011. Multiple sclerosis: pathogenesis and treatment. Current neuropharmacology, 9(3), pp.409-416.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 2, 2021

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