Individual, variable disease courses with unreliable prognosis

Patients who are first diagnosed with multiple sclerosis are generally between the ages of 20 and 40 years. The disease course varies greatly. The following are the basic forms of disease course:

  • Relapsing, remitting multiple sclerosis (RRMS): 85 to 90% of all patients have this form of MS. It is characterized by so-called attacks, phases of neurological symptoms which usually partially or completely resolve within a few weeks. If changes typical of MS are found in MRT or spinal fluid for the first time, neurologists nowadays call this first attack a clinically isolated syndrome (CIS). A CIS does not always develop into MS.
  • Secondary progressive MS (SPMS): In the course of time most patients with RRMS develop secondary progressive MS, above all with insufficient therapy. The main characteristic is a slow clinical deterioration which is independent of attacks.
  • Primary progressive MS (PPMS): 10 to 15% of all MS patients have from the disease onset a gradual progression of the disease, usually without any relapses or remissions. Physicians call this a primary progressive MS.
  • Benign MS: Some MS patients (approximately 5%) remain without any disability for decades. This group is referred to as having „benign MS“. Cognition and concentration need to be controlled regularly in these patients.

Accurate and individual prognoses of the disease course are difficult to impossible. However, there are some factors which may indicate a favorable course:

  • Onset of symptoms at a young age (< 40 years)
  • Initial symptoms are optic nerve inflammation (optic neuritis) or sensory disturbances
  • Relapsing-remitting course
  • Low rate of attacks
  • complete remission of the attacks
  • female gender

In general, researchers say that about one-third of all MS patients are not affected by any major disabilities. A further third of patients develop neurological deficits which affect their daily routine but which still allow them to work and have families. Only one-third of all MS patients suffer considerable disabilities which lead to occupational incapacity and often long-term care.


Various diseases courses in MS. Source: Heinz Wiendl/Bernd C. Kieseier: Multiple Sklerose. Klinik, Diagnostik und Therapie, Kohlhammer Verlag 2010.