Is There Really Such a Thing as “Mild MS”?

You can catch a slight cold, suffer occasional hay fever, maybe even battle a round of allergies… but can you really have “mild” multiple sclerosis? The experts are divided.

MS affects everyone differently and symptoms can vary hugely. The way the disease progresses over time also varies greatly ; some people’s symptoms are barely noticeable and take years to progress, while others experience rapid progression from the beginning. But generally speaking, most people’s MS follows a recognised pattern that allows doctors to label it as one of two forms:

Relapsing-remitting MS (RRMS) – this is characterised by flare-ups followed by periods when symptoms improve or disappear altogether. Around 85% of people with MS are diagnosed with this form . Secondary progressive MS (SPMS) is the latter stage of RRMS, when initial unpredictable relapses are accompanied by a progressive disability. Around 65% of people with RRMS transition to SPMS within 15 years of diagnosis .

Primary Progressive MS (PPMS) – is when symptoms get progressively worse from the outset with no periods of remission. Thankfully, this is a relatively rare form of MS, diagnosed in around 10 to 15% of patients .

Are You an MS Misfit?

Unfortunately (or fortunately, depending on how you look at it) some people diagnosed with MS don’t fit so neatly into either box. In these cases, one may visit their doctor to discuss their symptoms post-diagnosis, those symptoms can go a bit quiet. There are no more symptoms, or if there are, they’re very mild. This appears to be the case for around 5 to 10% of people with MS , leading some experts to suggest “benign” or “mild” MS as a category in itself. Generally speaking, if you have MS with mild symptoms, which haven’t progressed after 15 years, then it’s considered benign .

The ‘Mild MS’ Treatment Debate

The thing is, some doctors reject the notion of benign MS altogether , arguing that mild symptoms early on don’t signify anything that the disease could simply be progressing more slowly, and may well switch to RRMS or SPMS later down the line.

There’s also the fact that just because there aren’t any obvious physical symptoms, it doesn’t mean the disease is inactive . In fact, one study published in Neurology found that nearly a third of people with mild MS did show progressive disease activity over a course of five years when cognitive tests and brain scans were taken into account . For this reason, some experts are advocating that even people with mild MS should be treated early with disease modifying therapies to prevent irreversible damage .

Predicting the Course of Mild MS

But what does this mean for people with mild MS symptoms? Some good news and some bad news. You’re probably wondering if your condition is likely to get any worse. This is the million-dollar question for anyone with MS, and, of course, the answer is… *drum roll*

No one yet knows. Yes, it would be nice if doctors carried crystal balls alongside their stethoscopes but, sadly, medical degrees don’t make them fortune-tellers.

That said, there are a few indicators which may be helpful when it comes to assessing your disease status. In the study above, for example, the researchers found that those with more brain lesions detected on scans were also more likely to develop signs of the disease .

Of course, everybody is different, which is why it’s vital to have regular check-ups with your neurologist regardless of your symptoms. This really is the only way to assess the activity of the disease and establish the most effective treatment plan for you.

No matter how mild your MS symptoms, looking after your health is something that should never be taken mildly.

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