Progression

The relapsing form of multiple sclerosis (MS) is called relapsing-remitting MS (RRMS) and is characterized by acute exacerbations. In contrast, progressive forms of MS are characterized by a slow deterioration and increasing neurological deficits. There are three forms of progressive MS. Approximately 15% of those with MS show a slow deterioration from the onset. In the second form, 10% have either primary-progressive MS (PPMS) and never experience acute disease attacks or 5% have what was termed progressive-relapsing MS (PRMS), and have occasional subsequent attacks. The third form, secondary-progressive MS (SPMS), is the major progressive subtype. These are people who begin to slowly worsen 5 to 15 years after the first relapse. Once relapsing patients enter a progressive phase, they either stop having relapses or continue to experience exacerbations while slowly worsening.

No two people have exactly the same symptoms. You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms get worse within weeks or months.

Documentation of a progressive course requires at least six months of observation by a doctor. Then observation over a year or two is often necessary to be confident of progression, since deficits can accumulate at a very gradual rate. The major defining feature of progressive MS is slow deterioration that occurs independently of acute disease relapses and doesn't reflect residual deficits from acute disease attacks. So basically, your symptoms keep getting worse despite having periods of exacerbations or remissions.

Now regarding MS and the sexes, it typically has a greater impact on women than on men, there are studies looking into how hormones and testosterone protect the brain because of this. These studies seem to indicate that higher levels of testosterone offer greater protection to men's brains. The mechanism for the testosterone results may be due to testosterone's ability to bind brain receptors directly. Alternatively, the brain protection might arise from testosterone conversion into estrogen, a hormone that is routinely generated from testosterone by the enzyme aromatase. Now either way, it appears that testosterone as well as estrogen are neuroprotective agents. Since MS is a degenerative disease, the ability to target a molecular controller of brain protection is felt to be an ideal way of combating it.

It's also felt that testosterone treatment is safe, well tolerated and may reduce symptoms, slow brain degeneration and increase muscle mass in men with RRMS, and this would in turn slow down any progression. It's felt that it may directly fight MS and its progression as well as providing a physical benefit. More of this is discussed in the later section entitled Gender Issues.

Since no two people experience MS in the same way, the progression of MS symptoms may look very different from one person to another. However, even when there are no symptoms, there is progression of damage to the central nervous system (CNS) over time.

In addition, the brain can compensate for some level of damage, so symptoms may be hidden for quite some time. That's why it's important to begin MS treatment as soon as possible after receiving a diagnosis.

General MS Progression

The long-term accumulation of progression-related MS symptoms can profoundly affect the physical and mental aspects of daily living.

After diagnosis, people with MS may experience sensory symptoms such as numbness, tingling, or visual loss. Early in MS progression, they may find that they recover completely from relapses, and have few relapses in their first years after diagnosis. It's also common early on in the disease to experience long intervals between relapses.

Later, as MS progresses, people may have difficulty with tremors, coordination, and walking. They may find that their relapses become more frequent, and that they are less able to recover from them.

Changes in Mobility - Since MS causes fatigue, balance problems, and weakness, many people find it difficult at some point to walk on their own. However, most people with MS remain able to walk, even if it's with a cane or crutches. Although some people with MS may frequently use a scooter or wheelchair, others may use them at times to help conserve their energy.

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MS Progression and Disability - The natural course of MS can result in a condition known as brain shrinkage or atrophy which is further discussed in our section Muscular & Cerebral Atrophy. As in the picture below, this is a condition in which you actually lose brain tissue. Treatment may protect you against brain shrinkage.

To figure out if disease is progressing, doctors use a scale called the Expanded Disability Status Scale (EDSS). The EDSS is a way of measuring physical disability. Two-thirds of those with MS will not progress past level 6 on the EDSS. The EDSS and the disability causing it is discussed in greater detail in the Disability section.

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Advanced MS Complications

MS is a progressive disease for which no cure has yet been found. Although there are treatments to manage the disease course, they are only partially effective and slow down progression for most patients. This means that some people's MS will worsen in spite of everything they and their doctors may attempt.

Being that MS is a progressive disease, the rate of progression differs from one person to another. Its unpredictability makes it so doctors can't say with any certainty how far or fast a person's MS is going to progress or what the outcome is likely to be. There are some factors that do seem to suggest a better or worse prognosis. Taking these factors into account can help you and your family plan more effectively for the future.

Sometimes MS symptoms can progress to the point that they significantly interfere with daily activities. Changes like this can threaten your self-confidence and feelings of self-worth. When this happens, remember that maintaining control and independence in everyday life doesn’t necessarily mean doing everything the same way you did it before. By allowing yourself to do things differently, you may regain some of what's been lost.

Those with more advanced MS are at greater risk for certain kinds of complications. Examples of these risks can include:

•	Osteoporosis (loss of bone density related to reduced mobility and exercise, as well as treatment with corticosteroids)

•	Pressure sores (damage to the skin caused by lack of mobility or long hours in a bed or wheelchair)

•	Aspiration pneumonia (a problem caused by swallowing problems that allow food particles in to the lungs)

•	Severe bladder or kidney infections (resulting from chronic urinary dysfunction)

To reduce the risk of any complications, it's important to schedule regular check-ups with the doctor that is treating your MS. Also, be sure to report any unusual fevers or changes in any symptoms - good or bad.