Relapsing Remitting Multiple Sclerosis: how much do you know about it?

Relapsing Remitting Multiple Sclerosis: how much do you know about it?

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What is Relapsing Remitting Multiple Sclerosis (RRMS)?

Multiple Sclerosis occurs when your body´s immune system attacks the central nervous system, damaging the myelin that protects nerve fibers. It`s believed that environmental factors trigger the disease in people whose genetics make them susceptible to MS.

There are several different forms of MS. Approximately 85% of patients present with a relapsing-remitting MS (RRMS) disease course.

Symptoms of a clinical relapse typically arise over days, worsen over several weeks and then gradually subside over several weeks or months. Residual enduring symptoms are possible, or they can resolve spontaneously. [1]

While there is no way to predict with any certainly how an individual´s disease will progress, four basic MS disease courses or types have been defined by the International Advisory Committee on Clinical Trials of MS in 2013: clinically isolated syndrome, relapsing remitting, secondary progressive and primary progressive. [2]

 

What is a Clinically Isolated Syndrome (CIS)?

CIS is a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. People who experience a CIS may or may not go on to develop MS.

When CIS is accompanied by lesions on a brain magnetic resonance imaging (MRI) that are similar to those seen in MS, the person has a high likelihood of a second episode of neurologic symptoms and diagnosis of relapsing remitting MS.

When CIS is not accompanied by MS-like lesions on a brain MRI, the person has a much lower likelihood of developing MS.

The 2017 diagnostic criteria for MS (McDonald criteria) make it posible to diagnose MS in a person with CIS who also has specific findings on brain MRI who are considered at high risk for developing MS. [3] As MRI improves the diagnosis of MS will be made more quickly and easily, and patients may be treated earlier. Early treatment of CIS has been shown to delay onset of MS.

 

What are the Symptoms of Relapsing Remitting Multiple Sclerosis?

RR MS is characterized by clearly defined attacks or relapses of new or increasing neurologic symptoms, followed by periods of partial or complete recovery (remissions). Relapses cannot be caused by fever or infection and must last more than 24- 48 hours.

There is no clinical progression of the disease during the periods of remission.

It´s the most common disease course, approximately 85 percent of patients with MS are initially diagnosed with RRMS. Younger patients are more likely to have this form of MS than older patients.

Some patients rarely have attacks and go years without having new clinical problems; others have frequent attacks. The prognosis varies widely and there is no predictable pattern for RRMS. There is no test that predicts specifically what will happen.

Some clinical factors, including older age, male sex, race, topology of presenting relapse, frequent relapses and accumulation of disability after disease onset, presence of lesions baseline MRI (lesion load), presence of oligoclonal bands (cerebrospinal fluid) and presence of lesions in the spinal cord could be predictive of a more active or aggressive disease course in early RRMS or CIS. [4]

The symptoms of RRMS vary widely including episodes of visual loss in one eye, balance and coordination problems, double vision, numbness, weakness and others. No two patients have the same symptoms.

Treatments for Relapsing Remitting Multiple Sclerosis

When treatment is required, relapses are usually treated with a high-dose course of powerful corticosteroids over a period of three to five days. These are given by intravenous (iv) infusion. You will be offered steroids if a relapse is serious and stops you doing the day-to-day tasks. We expect them to shorten the duration of the relapse and speed up recovery from it.

After many years (usually within 15 to 20 years), many, but not all, people with relapsing remitting MS go on to develop secondary progressive MS. [4] Symptoms gradually worsen over time without obvious attacks, having infrequent relapses during this stage.

Disease modifying therapies (DMTs) are used to treat types of MS where you get relapses. They can reduce how many relapses you get and can slow down the progression disease.

Bibliography

  1. Weinshenker BD. Natural history of multiple sclerosis. Ann Neurol1994; 36(Suppl):S6–S11.
  2. Lublin FD, Reingold SC, Cohen JA et al. Defining the clinical course of multiple sclerosis. Neurology July 15, 2014 (83): 278-286
  3. Thompson, AJ; Banwell, BL; Barkhof, F; et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17 (2) pp. 162-173. 10.1016/S1474-4422(17)30470-2.
  4. Oh J, Vidal-Jordana A, Montalban X. Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018 Dec: 31 (6): 752-759. Doi: 10.1097/WCO.0000000000000622
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