Progression of multiple sclerosis (MS) is the main determining factor of extent of disability, hence, the main cause of financial burden in these patients. Multiple sclerosis may show worsening in disability right from the onset of the disease or it may show progression of disability after some time of initiation of the disease. Symptoms of multiple sclerosis differ from patient to patients and also differ throughout one person’s life. This is the main cause of difficult diagnosis of this disease.1
How Does Multiple Sclerosis Progress?
In the starting stage, most of the people with multiple sclerosis feel that the symptoms are increasing day by day which are presented as repetition or occurrence of frequent attacks. When people experience a relapse, he or she may be having new symptoms or just having an increase in the symptoms intensity the patient is already experiencing. These symptoms may last for a short period of time or for few days or may last for years depending on multiple sclerosis stage and severity. Relapse is an important characteristic of progression of multiple sclerosis, sometimes occurring along with neurological symptoms that last for more than 1 day in absence of fever or infections.2
Most multiple sclerosis patients have attacks of neurological dysfunction in of relapsing–remitting form of the disease, which is followed by nearly complete recovery. In secondary form of this disease, neurologic impairment progresses gradually, which may be accompanied by episodes of relapses. Approximately every 15 of 100 multiple sclerosis patient suffer from primary progressive disease, characterized by lack of well-defined episodes of relapses and remissions, from the very start of the disease.3
The diagnosis is based on the patient’s clinical conditions that the patient is currently having. It may be diagnosed in later years when the disease starts progressing and the body functions start to decline. The disease may take time to be diagnosed as your doctor needs to confirm the type of disease you are suffering from (primary progressive or secondary progressive).4
Although, some patients with relapse-remitting disease recover completely after having one or two attacks, the disease is fast progressing leading to permanent disability, or even death in some cases.5
Multiple sclerosis may involve spinal cord in males which is difficult to treat leading to early disability. The relapsing form of multiple sclerosis is known to occur in around 5% of multiple sclerosis patients. It may be present from start of disease along with additional acute attacks.5
More than 50% of patients suffer from cognitive difficulties but it is known to decrease over time. It is interesting to note that people who do not show any symptoms even after radiography may have multiple sclerosis along with hidden cognitive deficits. In addition to this, people with multiple sclerosis and normal cognitive function may also have abnormal brain function that can further complicate this disease condition. Cognitive disturbance might not be diagnosed in patients until his/her brain efficiency start declining on certain point of time, which varies from person to person.6
The diagnosis of multiple sclerosis is mainly based on the patient symptoms when the disease starts to progress and body function start declining.
- Thompson AJ. A much-needed focus on progression in multiple sclerosis. Lancet Neurol. 2015 Feb;14(2):133-5.
- Part-I: Understanding the progression in MS. Adapted from: https://mymsaa.org/publications/understanding-progression-ms/part-i-understanding-progression/ [Accessed on 4/6/2019]
- McDonald WI. Relapse, remission, and progression in multiple sclerosis. N Engl J Med. 2000 Nov 16;343(20):1486-7.
- Rice CM, Cottrell D, Wilkins A, et al. Primary progressive multiple sclerosis: progress and challenges. J Neurol Neurosurg Psychiatry 2013;84:1100–1106.
- Multiple sclerosis (MS). Adapted from: https://www.myvmc.com/diseases/multiple-sclerosis-ms/ [Accessed on 4/6/2019]
- Cerqueira JJ, Compston DAS, Geraldes R, et al. Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? J Neurol Neurosurg Psychiatry. 2018 Aug;89(8):844-850.
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