Multiple Sclerosis (MS)


Relapsing-remitting multiple sclerosis (RRMS) is one of the most common courses of disease in multiple sclerosis (MS), making up 85% of all newly diagnosed cases.1 It is characterized by exacerbations not caused by fever or infection that last more than 48 hours and are followed by periods of partial or complete remission. These periods of remission can last from months to years.2

RRMS can be active or not active. It can also be worsening or not worsening. Active RRMS is characterized by relapses and/or evidence of new brain lesions and worsening RRMS is characterized by a confirmed increase in disability following a relapse.1

Relapsing-Remitting MS Causes

Multiple sclerosis is caused by an immune system attack on the nervous system, resulting in damage to the myelin sheath. The exact cause of MS is not well understood, but research suggests it develops as a result of environmental triggers in people who have a genetic predisposition. The disease usually develops in patients in their 20s and 30s, and it is 2 to 3 times more common in women than in men.3

Environmental risk factors of MS include Epstein-Barr virus infections, smoking, vitamin D deficiency, and climate.4

Relapsing-Remitting MS Symptoms

RRMS symptoms include episodes of double vision or vision loss in one eye, tingling or numbness, fatigue, urinary urgency, balance problems, lack of coordination, and cognitive issues.1,2

Because MS lesions can form anywhere in the central nervous system, symptoms can vary greatly from one patient to another. Symptoms may also vary over time in the same patient. 

Some forms of RRMS are mild; patients may need to use a cane or mobility device. In other cases, the disease can be severe and affect a patient’s independence considerably.3 It is not possible to predict the severity or the progression of the disease.

Relapsing-Remitting MS Diagnosis

The diagnosis of RRMS is the same as any other form of the disease. There are no diagnostic tests that can differentiate or predict the different disease courses.

Diagnosis starts with the patient’s medical history and blood tests to rule out other conditions. If MS is suspected based on the patient’s symptoms, a physical exam should follow to assess the patient’s vision, balance, and other functions.

Magnetic resonance imaging (MRI) of the central nervous system can confirm the presence of MS lesions and aid in the diagnosis. Visual evoked potentials can be used to assess the function of the visual pathway from the retina to the occipital cortex.3 Cerebrospinal fluid analysis to assess the presence of oligoclonal bands can also aid in diagnosis. 

The criteria for the diagnosis of RRMS is evidence of at least 2 separate areas of damage in the brain or spinal cord disseminated in time.5

Relapsing-Remitting MS Treatment

Several disease-modifying treatments can be used in MS, and all of them have been tested in people with RRMS. They have been shown to reduce the number of relapses and MRI activity. They may also reduce disability in some cases.2

These disease-modifying treatments can be categorized into 5 main groups: beta-interferons, glatiramer acetate, monoclonal antibodies, dimethyl fumarate, and fingolimod.3 They all aim to reduce inflammation and slow disease progression.

Other medications can be prescribed to ease the symptoms of the disease.3 These include muscle relaxants for muscle spasms, medications to treat bladder dysfunction, antidepressants, medications to treat erectile dysfunction, and medications to address fatigue.

In some cases, corticosteroids may be prescribed to reduce the symptoms of RRMS during relapses.6 Finally, physical therapy may help relieve some symptoms of the disease, such as muscle spasms.7

Eating a diet low in saturated fats and trans fats and high in fresh fruits, vegetables, and omega-3 fatty acids can also help reduce the symptoms of the disease.8 Lifestyle changes such as getting enough exercise and sleep and avoiding smoking and excessive alcohol consumption can also help.

Relapsing-Remitting MS Prognosis

The prognosis of RRMS varies widely from patient to patient, with some rarely having relapses and going years without having any clinical problems, while others have frequent relapses and require extensive medical attention. There are no tests that can predict prognosis. RRMS sometimes progresses to secondary progressive MS, but this generally occurs in patients who have been living with RRMS for at least 10 years.1 

The average life expectancy is slightly reduced for people with MS.9

References

  1. Relapsing-remitting MS (RRMS). National Multiple Sclerosis Society. Accessed June 11, 2021.
  2. MS: relapsing remitting multiple sclerosis (RRMS). Cleveland Clinic. Accessed June 11, 2021.
  3. Relapsing-remitting multiple sclerosis. Johns Hopkins Medicine. Accessed June 11, 2021.
  4. Wingerchuk DM. Environmental factors in multiple sclerosis: Epstein-Barr virus, vitamin D, and cigarette smoking. Mt Sinai J Med. 2011;78(2):221-230. doi:10.1002/msj.20240
  5. Diagnosing RRMS. National Multiple Sclerosis Society. Accessed June 11, 2021.
  6. Steroids (methylprednisolone). Multiple Sclerosis Trust. Updated December 2017. Accessed June 11, 2021.
  7. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis — an integral component of disease management. EPMA J. 2011;3(1):2. doi:10.1007/s13167-011-0136-4 
  8. Sand IK. The role of diet in multiple sclerosis: mechanistic connections and current evidence. Curr Nutr Rep. 2018;7(3):150-160. doi:10.1007/s13668-018-0236-z
  9. Overview – multiple sclerosis. NHS. Accessed June 11, 2021.

Reviewed by Kyle Habet, MD on 7/1/2021

Reviewed by Kyle Habet, MD, on 7/1/2021.