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This section has been developed to provide an online mutual support and Information forum. Registered users are given a greater level of interaction with other users, so that a true World of MS community may be created.
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The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:
Relapsing-Remitting MS
In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years. About 85% of people are initially diagnosed with Relapsing Remitting MS.
When deficits always resolve between attacks this is sometimes referred to as Benign MS. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorised as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory).
Primary Progressive MS
Approximately 10% of individuals are diagnosed with this form of MS, which is characterised by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years.
Secondary Progressive MS
For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses and no definite periods of remission.
Progressive relapsing MS
This is the least common subtype (approximately 5%). Individuals show a steady neurologic decline with a clear superimposition of attacks. There may or may not be some form of recovery following these relapses, but the disease continues to progress without remissions.
Course of MS
It is impossible to predict accurately the course of MS for any individual, but the first five years give some indication of how the disease will continue for that person. This is based upon the course of the disease over that period and the disease type. (i.e relapsing- remitting or progressive ). The level of disability reached at end points such as five and ten years is thought to be a reliable predictor of the future course of the disease.
However, there are many variables in this scenario:
- A large percentage of people with MS (approx 45%) are not severely affected by MS and live normal and productive lives
- There is a significant group (40%) which become progressive after a period of some years as relapsing-remitting
Age at onset and gender may also be indicators of the long-term course of the disease. Some research has indicated that younger age at onset [under 16 years of age] implies a more favourable prognosis, but this must be tempered by the knowledge that for a young adult living with MS for 20 or 30 years may result in substantial disability even if the progress towards disability is slow and in the first 10 or 15 years he or she is relatively mildly affected. Other research has indicated that late onset [ie over 55 years of age], particularly in males, may indicate a progressive course of the disease.
The prospect of therapy for MS should be encouraging to those newly diagnosed with MS. Drugs such as interferon beta are possible treatments for those who are relapsing-remitting and ambulatory. The interferon betas may slow the progression of disability as well as reduce the severity and frequency of exacerbations. At this stage it is not known whether interferon beta has any impact on primary progressive MS. The breadth of research currently targeting MS gives hope that therapy which will interfere with the process of MS (even if not curing the disease) is not an unreasonable expectation in the near future.
It should be remembered that many people with MS go through life with a manageable disability (e.g. fatigue, a limp, bladder problems). At least 15% of people with MS, however, will become severely disabled (i.e.having to use a wheelchair on a full-time basis). Life expectancy for persons with MS is near normal.
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