3 Relapsing Forms of MS | MyMSTeam

Connect with others who understand.

sign up Log in
Resources
About MyMSTeam
Powered By

3 Relapsing Forms of MS

Medically reviewed by Federica Polidoro, M.D.
Written by Brooke Dulka, Ph.D.
Updated on January 2, 2024

  • The three relapsing forms of multiple sclerosis (MS) are clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and active secondary progressive MS (SPMS).
  • Relapsing forms of MS can transition to more progressive forms of the disease.
  • Long-term treatment with disease-modifying therapies (DMTs) is the most effective way to delay MS progression.

MS can take different disease courses, and each represents a different type of MS. Only certain types of MS have a risk of relapses — also known as flare-ups, exacerbations, or attacks. Relapses are periods of new or worsening symptoms of MS. Doctors sometimes disagree about the exact nature of MS, but relapsing forms are often treated using the same medication options.

There are three types of relapsing MS: clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS.

1. Clinically Isolated Syndrome

CIS is often the first episode of symptoms a person will experience that eventually lead to a diagnosis of MS. CIS is diagnosed after you have been experiencing neurological MS symptoms for at least 24 hours. These symptoms must be caused by demyelination (damage to the myelin that sheathes nerve fibers) or inflammation in the central nervous system (CNS).

CIS is a condition that can convert (or progress) to MS. The risk of conversion is often predicted based on the quantity and size of brain lesions, as seen on initial baseline MRI scans. CIS is usually diagnosed in people between the ages of 20 and 40. Effective treatment soon after a diagnosis of CIS is important to delay the conversion to MS.

2. Relapsing-Remitting Multiple Sclerosis

RRMS is the most common form of MS. However, no two people experience RRMS the same way. This is because lesions can occur in different locations within the CNS, affecting different functions.

RRMS is characterized by defined attacks of new symptoms or symptoms worsening in severity. There are several risk factors for RRMS. Women are approximately two to three times more likely than men to be diagnosed with RRMS, according to Mayo Clinic. The age of onset for RRMS is similar to that of CIS — between ages 20 and 40. However, children can also be diagnosed with this course of MS. Genetics pose another risk factor, as RRMS can run in families.

Learn more about what MS relapses feel and look like.

3. Active Secondary Progressive Multiple Sclerosis

After a period of time, RRMS can progress to secondary progressive MS. In people with progressive disease, neurological symptoms continue to get worse, without clear periods of remission. SPMS is considered active if relapses continue to occur and inactive if there have been no relapses for a while. According to the National Multiple Sclerosis Society, without the use of approved DMTs, 50 percent of people diagnosed with RRMS will likely transition to SPMS within 10 years, and 90 percent tend to transition within 25 years.

Although CIS, RRMS, and SPMS are distinct forms of relapsing MS, they are often grouped together and have similar treatment options.

Read about how long MS relapses last.

Treatment Options for Relapsing Forms of MS

Disease-modifying therapies are the primary defense against progression in relapsing forms of MS. The U.S. Food and Drug Administration (FDA) has approved more than 20 DMTs for treating relapsing forms of MS.

Research suggests DMTs can:

  • Reduce the frequency of MS relapses
  • Limit new MS activity, such as lesions or plaques on the brain and spinal cord, as shown on MRI scans
  • Slow disease progression, including conversion from CIS to RRMS or from RRMS to active SPMS

People diagnosed with any type of relapsing MS should discuss DMTs with a doctor as soon as possible. Early treatment can make a positive difference in reducing the rate of relapses and slowing the progression of MS.

At times, an MS flare may require emergency treatment or hospitalization.

Classes of DMTs for Relapsing Forms of MS

Different classes of medications are used as DMTs in cases of relapsing MS. Each class works in a different way, and your neurologist can help you decide on the best treatment option for you.

Classes of drugs used as DMTs for MS include:

  • Interferons, such as interferon beta-1a (Avonex) and interferon beta-1b (Betaseron)
  • Monoclonal antibodies, such as ofatumumab (Kesimpta), ocrelizumab (Ocrevus) and natalizumab (Tysabri)
  • Fumarates, such as dimethyl fumarate (Tecfidera) and diroximel fumarate (Vumerity)
  • Cladribine (Mavenclad), an adenosine analog
  • Sphingosine-1-phosphate receptor modulators, such as fingolimod (Gilenya) and siponimod (Mayzent)
  • Pyrimidine synthesis inhibitors, such as teriflunomide (Aubagio)

Delaying MS Progression

MS is a debilitating disease that will progress (continue to worsen) as time goes by. There is not yet a cure for MS. However, beginning a DMT treatment as early as possible after diagnosis can help delay the progression to more debilitating forms of MS.

There are several MS drugs recently approved or in clinical trials. At present, it is largely unknown how these medications might delay or lower the risk of MS progression in the long term. Long-term treatment with a DMT is the single most important factor in delaying MS progression.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 205,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with a relapsing form of multiple sclerosis? Do you worry about progression? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Types of MS — National Multiple Sclerosis Society
  2. Will the Real Multiple Sclerosis Please Stand Up? — Nature Reviews Neuroscience
  3. Inflammation in Multiple Sclerosis: The Good, the Bad, and the Complex — The Lancet Neurology
  4. Multiple Sclerosis: An Immune or Neurodegenerative Disorder? — Annual Review of Neuroscience
  5. The Prevalence of MS in the United States: A Population-Based Estimate Using Health Claims Data — Neurology
  6. Clinically Isolated Syndrome (CIS) — National Multiple Sclerosis Society
  7. Conversion From Clinically Isolated Syndrome to Multiple Sclerosis: A Large Multicentre Study — Multiple Sclerosis Journal
  8. Updates on Clinically Isolated Syndrome and Diagnostic Criteria for Multiple Sclerosis — The Neurohospitalist
  9. Relapsing-Remitting MS (RRMS) — National Multiple Sclerosis Society
  10. Heterogeneity of Multiple Sclerosis Lesions: Implications for the Pathogenesis of Demyelination — Annals of Neurology
  11. Multiple Sclerosis — Mayo Clinic
  12. Modest Familial Risks for Multiple Sclerosis: A Registry-Based Study of the Population of Sweden — Brain
  13. Secondary Progressive Multiple Sclerosis (SPMS) — National Multiple Sclerosis Society
  14. Treating RRMS — National Multiple Sclerosis Society
  15. Advances in the Treatment of Multiple Sclerosis — Neurologic Clinics
  16. Treatment Strategies for Multiple Sclerosis: When To Start, When To Change, When To Stop? — World Journal of Clinical Cases
  17. Treatment for MS — MS Focus
  18. Sphingosine 1-Phosphate Receptor Modulators in Multiple Sclerosis — CNS Drugs
  19. The Effect of Immunomodulatory Treatment on Multiple Sclerosis Fatigue — Journal of Neurology, Neurosurgery & Psychiatry
  20. Immunosuppressive Agents in Multiple Sclerosis — Neurotherapeutics
  21. Transition to Secondary Progression in Relapsing-Onset Multiple Sclerosis: Definitions and Risk Factors — Multiple Sclerosis Journal
  22. Explore Treatments in Trials — MS Society
    Updated on January 2, 2024
    All updates must be accompanied by text or a picture.

    We'd love to hear from you! Please share your name and email to post and read comments.

    You'll also get the latest articles directly to your inbox.

    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
    Federica Polidoro, M.D. a graduate of medical school and neurology residency in Italy, furthered her expertise through a research fellowship in multiple sclerosis at Imperial College London. Learn more about her here.
    Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

    Related Articles

    When multiple sclerosis (MS) symptoms intensify, worsening anxiety and discomfort can make it har...

    Emergencies and Hospital Stays for MS Relapse: When To Go and What It Means for Treatment

    When multiple sclerosis (MS) symptoms intensify, worsening anxiety and discomfort can make it har...
    If you feel like you are coughing more since being diagnosed with MS or that you deal with a lot ...

    MS and Coughing: Tips for Mucus, Throat Clearing, and More

    If you feel like you are coughing more since being diagnosed with MS or that you deal with a lot ...
    Relapses, or periods of increased symptoms and disease activity, are common in relapsing forms of...

    How Long Does an MS Relapse Last?

    Relapses, or periods of increased symptoms and disease activity, are common in relapsing forms of...
    Multiple sclerosis (MS) relapses are different for everyone.An MS relapse, or flare-up, is the ap...

    What Do MS Flare-Ups Feel and Look Like?

    Multiple sclerosis (MS) relapses are different for everyone.An MS relapse, or flare-up, is the ap...
    Many people with multiple sclerosis (MS) experience periods of new or worsening symptoms. These e...

    8 Symptoms of MS Relapse: How To Know if You’re Having a Flare

    Many people with multiple sclerosis (MS) experience periods of new or worsening symptoms. These e...
    Many people with multiple sclerosis (MS) have questions about whether dental work and root canals...

    Do Root Canals Cause MS or Trigger Flares?

    Many people with multiple sclerosis (MS) have questions about whether dental work and root canals...

    Recent Articles

    Although treatment options for multiple sclerosis (MS) have improved, people with the condition s...

    Top 4 Causes of Death in People With MS

    Although treatment options for multiple sclerosis (MS) have improved, people with the condition s...
    No diet can cure multiple sclerosis (MS), but some people who follow the Swank diet say it helps ...

    Swank Diet for Relapsing MS: What You Should Know

    No diet can cure multiple sclerosis (MS), but some people who follow the Swank diet say it helps ...
    Below the surface, living with multiple sclerosis (MS) can mean days spent in bed, missed appoint...

    MS: What People Don’t See (Interactive Infographic)

    Below the surface, living with multiple sclerosis (MS) can mean days spent in bed, missed appoint...
    MyHealthTeam does not provide health services, and if you need help, we’d strongly encourage you ...

    Crisis Resources

    MyHealthTeam does not provide health services, and if you need help, we’d strongly encourage you ...
    Ozempic (a brand name for semaglutide) and similar drugs are all over the news. They were even na...

    Ozempic and Multiple Sclerosis: Insights From Dr. Aaron Boster on GLP-1 Agonists

    Ozempic (a brand name for semaglutide) and similar drugs are all over the news. They were even na...
    Hormones — when you think of the term, you probably picture a moody teenager going through pubert...

    Hormones and MS: 8 Facts To Know

    Hormones — when you think of the term, you probably picture a moody teenager going through pubert...
    MyMSTeam My multiple sclerosis Team

    Thank you for subscribing!

    Become a member to get even more:

    sign up for free

    close