Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis

Box 1

Types of MS. Adapted from Polman et al. [11].

Relapsing remitting MS (RRMS) occurs in 80% of MS cases at onset. It is characterized by relapses, which evolve over days

to weeks, with full recovery or with sequelae and residual deficit upon recovery. Between attacks, the patient is

neurologically and symptomatically stable.

Secondary progressive MS (SPMS) may begin as RRMS, but at some point, the attack rate reduces and the course shows

steady deterioration in function unrelated to acute attacks.

Primary progressive MS (PPMS) accounts for 10% of cases at disease onset and is characterized by steady decline in

function from the beginning without acute attacks. These patients have a more even sex distribution, tend to have later age

of onset, and may have a worse prognosis for ultimate disability compared with those with RRMS.

Progressive relapsing MS (PRMS) (<5%) also begins with a progressive course although these patients also experience

occasional attacks.