Multiple sclerosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Multiple sclerosis may be classified into four groups according to the clinical course of the disease. This includes relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing.

Classification

• Multiple sclerosis may be classified according to its clinical course into four groups:
• In 1996, US National Multiple Sclerosis Society (NMSS) defined multiple sclerosis subtypes according to clinical manifestations.
• The fact that the clinical course of the disease is a dynamic process makes it possible that the subtypes switch to each other over time.

Subtypes	Explanation
Relapsing remitting	Relapsing-remitting multiple sclerosis (RRMS) is defined by acute attacks of neurological dysfunction followed by full or partial recovery. Patient clinical symptoms are stable between the attacks
Secondary progressive	Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the neurological symptoms progressively worsen between the attacks
Primary progressive	Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of neurological dysfunction with no distinct attacks and remissions
Progressive relapsing	Progressive relapsing multiple sclerosis (PRMS) is defined by progression of disease from the beginning with acute attack episodes

Other new multiple sclerosis subclasses

• In recent studies a new subtype of multiple sclerosis was defined as "clinically isolated syndrome (CIS)." It is when the clinical presentation of a disease is suggestive of myelin sheath inflammation but cannot fulfill the diagnostic criteria of MS.

• Another associated termination regarding MS classification is "radiologically isolated syndrome (RIS)." It defines as radiological findings of myelin sheath inflammation without any sign or symptoms in patient. RIS can be an indicator of early stages of MS disease, but it's not a subgroup of MS because radiological finding of inflammatory demyelination without any sign or symptoms of the disease is nonspecific.