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What Are the Four Stages of MS?

Multiple sclerosis (MS) is an autoimmune disease that disrupts the connections in the brain and spinal cord. There are four stages of MS, starting with initial diagnosis and learning to live with the disease, to a loss of mobility and severe complications.
Multiple sclerosis (MS) is an autoimmune disease that disrupts the connections in the brain and spinal cord. There are four stages of MS, starting with initial diagnosis and learning to live with the disease, to a loss of mobility and severe complications.

Multiple sclerosis (MS) is an autoimmune disease in which the body attacks and damages the myelin sheath that surrounds the nerve cells, which disrupts the connections in the brain and spinal cord and results in a variety of symptoms. 

There are four different types of multiple sclerosis, as outline in the table below.

Types of MS
MS Type Characteristics
Relapsing-remitting
  • The most common type of MS
  • Symptoms come and go
  • When symptoms flare up, it is called an attack or relapse which can last days to weeks 
  • Between attacks, people may feel normal
Secondary progressive
  • Symptoms come and go at first but eventually worsen
Primary progressive
  • Symptoms steadily worsen from the onset
Progressive relapsing
  • Symptoms steadily worsen, along with attacks that come and go

Each type of MS can progress differently and people may be considered to be going through different stages, which are described in the table below.

Stages of MS
MS Stage Characteristics

Stage 1: Learning to live with the disease
  • This stage follows the initial diagnosis, where patients learn what to expect
Stage 2: Moderate disability
  • Patients are still mostly independent, but may need assistance such as a cane or walker
Stage 3: Severe disability
  • About 25% of patients with MS will need a wheelchair at this point and will need to rely on others for assistance

Stage 4: End stage
  • This is the final stage of MS 
  • Patients have lost physical mobility and independence
  • Severe and life-threatening complications can occur

What Are Symptoms of Multiple Sclerosis (MS)?

Symptoms of multiple sclerosis (MS) can vary from mild, to moderate, to severe and may include:

  • Numbness, tingling, “pins and needles” feeling
  • Electric shock sensations that accompany certain neck movements (Lhermitte sign)
  • Muscle weakness or spasms
  • Fatigue
  • Vision/eye problems
    • Hazy vision
    • Blurred vision
    • Double vision 
    • Loss of color perception
    • eye pain
    • Unusual eye movements
  • Dizziness
  • Spinning sensation (vertigo)
  • Lack of coordination 
  • Loss of balance/falls
  • Problems walking or speaking
  • Bowel or bladder problems
  • Sexual dysfunction 
  • Sensitivity to heat (may worsen symptoms)
  • Problems thinking clearly
  • Memory problems
  • Mood swings

Children may have any/all of the above symptoms along with seizures and extreme fatigue.

What Causes Multiple Sclerosis (MS)?

The cause of multiple sclerosis (MS) is unknown, but it is thought to be a combination of factors, including:

  • Genetics
  • Environment
  • Immune system dysfunction
  • Infections

How Is Multiple Sclerosis (MS) Diagnosed?

In addition to a patient history and physical examination, when multiple sclerosis (MS) is suspected, tests that can help confirm a diagnosis include: 

  • Magnetic resonance imaging (MRI)
  • Lumbar puncture (also called a “spinal tap”) 
  • Evoked potentials (or evoked responses) tests electrical signals in the brain and spinal cord
  • Optical coherence tomography 
  • Blood tests to rule out other conditions that can cause symptoms similar to MS

Nerve damage may be detected but multiple sclerosis may not be diagnosed initially. MS is often only diagnosed after observing symptoms and comparing test results over time. 


 

What Is the Treatment for Multiple Sclerosis (MS)?

Treatment for multiple sclerosis (MS) depends on the type of MS. 

Treatment for MS attacks includes steroids to reduce inflammation.

Disease-modifying therapy medications can help reduce flares and can help slow down progressive MS:

  • Injectable medications
    • Glatiramer acetate (Copaxone, Glatopa)
    • Interferon beta-1a (Avonex, Rebif)
    • Interferon beta-1b (Betaseron, Extavia)
    • Ofatumumab (Kesimpta)
    • Peginterferon beta-1a (Plegridy)
  • Oral medications
    • Cladribine (Mavenclad)
    • Dimethyl fumarate (Tecfidera)
    • Diroximel fumarate (Vumerity)
    • Fingolimod (Gilenya)
    • Monomethyl fumarate (Bafiertam)
    • Ozanimod (Zeposia)
    • Siponimod (Mayzent)
    • Teriflunomide (Aubagio)
  • Infused medications
    • Alemtuzumab (Lemtrada)
    • Mitoxantrone (Novantrone)
    • Natalizumab (Tysabri)
    • Ocrelizumab (Ocrevus)

Additional medications may be used to treat specific symptoms of MS, such as: 

  • Antibiotics for infections 
  • Antidepressants and anti-seizure medications for nerve pain
  • Antidepressants for depression and mood changes
  • Antihistamines for itching
  • Bladder and bowel medications for bladder and bowel dysfunction
  • Central nervous system stimulants for fatigue
  • Erectile dysfunction medicines for sexual dysfunction
  • Medications to treat dizziness and vertigo
  • Medicines to treat tremors
  • Muscle relaxants, benzodiazepines, and onabotulinumtoxinA (Botox) for muscle spasms
  • Potassium channel blockers to treat difficulty walking

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References
https://www.uptodate.com/contents/multiple-sclerosis-in-adults-the-basics?search=Multiple%20Sclerosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.nationalmssociety.org/

http://survivingms.com/5-stages-multiple-sclerosis-stage-2/