Living with multiple sclerosis means living with uncertainty. The course of the disease is very difficult for doctors to predict. Some people live with MS for years without suffering serious symptoms. Others may rapidly become disabled. Why the course of the disease varies so widely remains unclear. One thing is certain. Most people with MS experience periodic relapses, also called flare-ups or attacks. These can be mild or severe. They may show up in many different ways. Symptoms can include:
“Between 85% and 95% of MS patients begin with what we call remitting/relapsing MS,” says Anne Cross, MD, professor of neurology at Washington University School of Medicine. During that phase of the disease, the pattern of relapses varies widely among patients. Some people have frequent relapses. Others have very few. The average is typically one to two attacks a year, according to Cross.
A person with primary progressive multiple sclerosis (PPMS) may first seek medical care because of leg weakness or difficulty walking. Those are the most common symptoms of this type of MS.
PPMS steadily worsens after it first develops. Neurological disability will accumulate over time. How fast or to what degree disability develops varies for each person and can't be predicted. And in PPMS -- unlike some other types of MS -- there are no relapses or remissions.
Ten percent to 15% of people with...
Research shows that these disease-modifying drugs can decrease the rate of relapses by about 30%. They also lessen the severity of relapses. Not all forms of MS respond to these drugs, however. And even when the drugs work, they do not offer a cure. Most people continue to experience periodic relapses.
When acute attacks occur, doctors can suppress the underlying autoimmune damage, which is at the heart of MS, with the use of corticosteroids. Studies have shown that corticosteroid treatments significantly reduce the severity and shorten the duration of relapses for most patients. A typical dose is between 500 and 1,000 milligrams of intravenous methylprednisolone, which is gradually reduced over several weeks.
“But there is no clear-cut best way to administer corticosteroids, so doctors usually go on the basis of their own clinical experience with the disease,” says Ben W. Thrower, MD, medical director of the Andrew C. Carlos Multiple Sclerosis Institute at the Shepherd Center in Atlanta.