Primary-Progressive vs. Relapsing-Remitting MS?

This distinction is important because it affects the way each type of MS is treated.

MS can be divided into two main types, based on whether or not new symptoms continue to develop over time (primary-progressive) or if they occur only in discrete attacks (relapsing-remitting). The primary-progressive (PPMS) form of the disease appears to involve more widespread damage to nerve cells than does relapsing-remitting MS. PPMS usually begins later in life than RRMS and progresses more gradually.

Symptoms may progress for several years without interruption, leading to disability that continues throughout an individual’s lifetime. While most people with RRMS can work full time throughout their lives without ever needing long-term disability benefits, some people with PPMS may not be able to work for more than 5-10 years after the onset of symptoms.

PPMS is less common than RRMS. Although it occurs equally in men and women, there are more instances of PPMS among Caucasians compared to other races. Disability from PPMS results most commonly from walking difficulties or problems with balance, though bladder and bowel dysfunction may also become major concerns.

There is no way to predict how MS will progress in an individual case. However, the course of the disease tends to be different in patients who experience their first symptoms at a younger age (regardless of whether they eventually develop primary progressive MS). The reason age at symptom onset matters is because, over time, most people with RRMS will transition to a form of the disease that is progressive.

In PPMS, the existing damage to nerve cells does not seem to heal or recover, and new symptoms do not appear in “attacks.” In most cases of RRMS, however, earlier deficits may improve over time as nerve cells repair themselves to some degree. Patients who have more active inflammation at the time of their first clinical event will usually have a more rapid course of MS initially. Disease activity tends to be lower later on during the illness.

Symptoms often include:

Tremor – People with primary-progressive MS tend to have tremors that are less rhythmic than those in people with relapsing-remitting MS, particularly when the arms are affected.

Cogwheel rigidity – Early on in primary-progressive MS (and usually within 20 years of symptom onset), people may develop stiffness in their limbs that is usually more severe in the lower part of the body. This type of tremor is called cogwheel rigidity. As it progresses, patients will have increasing difficulty walking and doing other tasks due to stiffness and clumsiness of their movements.

Symptoms tend to show up on one side of the body at first (“asymmetric”), with greater weakness or clumsiness on one side than on the other. Sensory problems are also present more often on the same side as muscle weakness.

Tremor – Compensatory tremors are more common in primary-progressive MS.

Movement disorders that occur more often in people with primary-progressive MS than in those with relapsing-remitting include:

Tremor – Cogwheel rigidity is a form of muscle tone disturbance caused by stiff muscles and tremors, which increases when the affected limb moves or is put under stress. It tends to be severe when walking or reaching out to grab something. The trembling may also be present without movement or stress on the part of the individual.

Crepitus – This term refers to the sound made by grating tissue together when joints are moved, which can be experienced as pain. Additionally, it can refer to any other type of abnormal, creaking, or grating noise made by the bones or muscles when they are in motion.

progressive relapsing ms

primary progressive ms prognosis

Relapsing-remitting multiple sclerosis:

Multiple sclerosis (MS) is a chronic disease that affects the nervous system. It leads to inflammation, demyelination, and sometimes destruction of myelin which in turn causes problems with communication between the brain and other parts of the body.

The most common symptoms are:

Numbness or tingling ( usually in the arms and legs but can be anywhere in your body)

Trouble walking and balance

Blurred vision (in early stages MS can lead to loss of vision). This may be for short periods only, but in severe cases, it may be permanent.

Fatigue (this is usually worse towards evening or after activity, It might also occur during warm weather)

Muscle spasms and stiffness (in the back, neck muscles, or muscles in your arms and legs)

Pain may be aching or sharp.

Loss of bladder control during sleep (called nocturia) means you have to get up during the night to go to the toilet.

Some less common symptoms can occur from time to time:

Sexual dysfunction includes loss of sex drive, problems getting an erection, and premature ejaculation. Some people with MS experience pain with intercourse or find they cannot have sex at all. Others might have a normal sex life but will have more sexual problems than other people their age. Depression can also affect some people with MS. It is estimated that 1 in 3 people who live with MS will experience depression at some point.

People with MS can also have cognitive difficulties which include problems with memory, concentration, and problem-solving. This is often called ‘brain fog’.

Some people with more aggressive forms of multiple sclerosis may lose the ability to walk gradually over time, their speech may become slurred and they might need to use a wheelchair for mobility.

Multiple Sclerosis (MS) is usually diagnosed between the ages of 20-40 but it does affect older people as well. It affects women 4 times more than men.

The most common cause of MS is unknown and there is no known cure for this disease. The symptoms can be treated and there are therapies to try and slow down its progression but we only have drugs that help to reduce the number of relapses and slow down disability.


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