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Progressive Relapsing Multiple Sclerosis

If you have progressive relapsing multiple sclerosis (PRMS), your condition will get steadily worse from the very beginning.

But you also will experience distinct relapses, with or without full recovery. Between relapses, the disease continues to gradually worsen.

PRMS is the least common type of multiple sclerosis. It affects about 5% of all people with MS.

Symptoms of Progressive Relapsing MS

No two people are likely to have the same set of MS symptoms in the same way. Some symptoms may come and go or appear once and not again. The symptoms you have depend on the area of the brain or spinal cord damaged.

The symptoms of PRMS may include:

  • Eye pain and vision problems, such as double vision or jumpy vision 
  • Numbness and tingling
  • Sensitivity to heat 
  • Radiating pain, like a mild electrical shock, when bending the neck
  • Dizziness
  • Bowel or bladder problems
  • Problems with sexual function
  • Trouble moving, stiffness
  • Weakness and fatigue
  • Problems with balance and coordination
  • Difficulty thinking clearly
  • Depression

A relapse can last anywhere from 24 hours to several weeks. During a relapse new symptoms occur or old symptoms temporarily worsen.

In PRMS, relapses may or may not be followed by some recovery. But there are no remissions.

Tell your doctor about a relapse as soon as possible. Treating it quickly may reduce permanent damage and disability.

Treatment With Disease-Modifying Drugs

People with PRMS take medications called disease-modifying drugs (DMDs). These drugs reduce the frequency and severity of relapses. They work by dulling the body's immune system.

DMDs may slow disease progression. This treatment may also be called immunotherapy or disease-modifying therapy (DMT). It is the cornerstone of treatment for most types of MS.

Several DMDs are taken by self-injection. These include:

Other DMDs require intravenous (IV) injection that is done at a clinic or hospital. They include:

More recently, three oral disease-modifying drugs were approved for MS. They are:

  • Aubagio (teriflunomide)
  • Gilenya (fingolimod)
  • Tecfidera (dimethyl fumarate)

All of these drugs have side effects, some more severe than others. Your doctor will want to monitor you closely and weigh the risks and benefits of each drug.

Treating Flare-ups With Steroids

PRMS is defined by relapses or flare-ups caused by inflammation of the brain and spinal cord. Damage to the sheath surrounding nerves results in problems sending nerve impulses and related symptoms.

A mild flare-up may not require treatment. But for more severe symptoms that interfere with your daily life, steroids (intravenous and sometimes oral) are often used.

A high-dose, short-term course of steroids helps reduce inflammation and the length and severity of the relapse.

Managing Symptoms

Symptoms of MS range from pain to bladder problems to fatigue to dizziness. For this reason, drugs used to treat symptoms are also as varied. Drugs that can be prescribed for the relief of symptoms include:

  • Antidepressants
  • Pain relievers
  • Medications to reduce fatigue

 

WebMD Medical Reference

Reviewed by Richard Senelick, MD on October 23, 2012
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