The clinical manifestation of symptoms (CMS) that lead to multiple sclerosis starts with the first symptomatic ‘attack’ indicative of the first signs of neurological damage (demyelination), a condition termed as ‘clinically isolated syndrome’ (CIS). This lasts for 24 hours and can involve a single site of damage (monofocal) or multiple sites of damage (multifocal). Monofocal attacks are manifested with a single symptom whereas multifocal attacks exhibit more than one symptom. An MRI should be done immediately after the first attack in order to ensure any probability of progression towards MS. The presence of one or more lesions on the CMS hints at a higher risk of progression with an expected second attack within a span of months or years.
There are four variations of multiple sclerosis:
- Relapsing-Remitting Multiple Sclerosis (RRMS): This is the most common form of MS with clear defined phases of relapse and repeat attacks (flare-ups/exacerbations), with progressive worsening of nerve functions with each attack, followed by phases of relief (remission) where normal conditions are restored totally or partially preceded by improvement from the symptomatic attacks. RRMS occurs in 85% of the cases.
- Secondary Progressive Multiple Sclerosis (SPMS): This follows RRMS, with continued relapses and progressive neurological damage accompanied by demyelination. It basically implies to a steady worsening of nerve damage, with or without remissions.
- Primary Progressive Multiple Sclerosis (PPMS): This represents a condition with steady progression with no remissions, only temporary relief. If the reactions are plotted graphically, there will be an occasional plateau but no gaps. This happens in 10% of the cases.
- Progressive Relapsing Multiple Sclerosis (PRMS): This is the rarest form of MS which can affect a person. This is a steady, progressively worsening condition right from the beginning with no short or long-term remission, but occasional relapses, which when plotted graphically, appear as peaks.