Primary progressive multiple sclerosis (PPMS) progresses gradually over time without periods of remission. In contrast, relapsing-remitting multiple sclerosis (RRMS) causes flare-ups with partial or full remission in between.
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. There are several forms, with RRMS being the most common.
In this article, we look at the similarities, differences, symptoms, and treatment for RRMS and PPMS.
Prevalence
Approximately
PPMS is less common, affecting approximately
Age of onset
The symptoms of RRMS typically begin between the ages of 20 and 30 years, although they can begin in childhood or later adulthood. PPMS symptoms generally occur later, often in people ages 40 to 50 years.
Symptom pattern
The hallmark symptom pattern of RRMS is relapses and remissions. A relapse is when symptoms flare up. A period of remission is when symptoms improve, either fully or only partially.
A relapse may affect the body similarly each time or may involve new and different symptoms. They can also last varying amounts of time.
In contrast, PPMS causes a progression of symptoms that may be unpredictable. Sometimes, people have brief periods of stability but not full remissions.
Pathophysiology
Both RRMS and PPMS involve damage to the myelin sheath, the protective covering of nerve fibers in the central nervous system. Researchers are still learning more about how the underlying mechanisms are similar and different.
RRMS occurs with periods of pronounced inflammation, whereas PPMS involves continuous nerve degeneration due to inflammatory damage. Inflammation may be especially pronounced in PPMS within the first few years after getting a diagnosis.
Determining which form of MS is worse can be challenging as it largely depends on individual circumstances. Each form of MS can have a mild, moderate, or severe disease course.
PPMS, with its gradual progression, may lead to a more continuous decline in function. To begin with, this may not be as pronounced as RRMS.
However, despite its relapses, RRMS often has periods of remission, which may last
Additionally, PPMS can be more difficult to diagnose and treat than RRMS, as there is less visible damage present in MRI scans.
Both RRMS and PPMS can potentially cause similar symptoms. As both affect the nervous system, they have similar effects.
However, PPMS
- impaired balance and coordination
- weakness
- stiffness
- electric shock-like sensations down the back
RRMS tends to cause more lesions in the brain, which can result in a range of symptoms such as:
- bowel and bladder problems
- episodes of fatigue
- visual impairments
- muscle weakness or stiffness
- numbness and tingling
- difficulties with coordination and balance
- cognitive changes (such as learning and memory or information processing)
- dysesthesia
- vertigo and dizziness
- limited mobility and walking difficulties
- balance problems
- slurred speech
- emotional changes
- depression
- sexual dysfunction
People with PPMS may also experience these symptoms, but it depends on how the condition affects them. In both types of MS, the symptoms can be unpredictable and vary widely between people.
Below are some other types of MS.
Secondary progressive MS (SPMS)
Secondary progressive MS (SPMS) often begins as RRMS and then transitions into a phase where neurologic function worsens unpredictably over time. Doctors consider it to be the second phase of the disease.
Approximately
Progressive-relapsing MS (PRMS)
Progressive-relapsing MS (PRMS) is the least common form of MS, occurring in approximately
Unlike PPMS, PRMS patients do not return to their previous level of health after relapses.
Treatment options vary for RRMS and PPMS. No single treatment plan is the same, and a doctor will tailor various treatment options to suit a person’s lifestyle, symptoms, and overall health.
This may involve a combination of:
- medications such as muscle relaxers, pain relievers, or steroids to treat symptoms and reduce the severity and duration of relapses
- physical, occupational, speech, or psychological therapies
- lifestyle adjustments such as eating a healthy diet, exercising, and using stress reduction techniques
- supportive care, which could include rehabilitation and assistive devices to maintain mobility and function
For RRMS, there are also
Ocrelizumab is the only disease-modifying medication specifically for PPMS, but sometimes, doctors may prescribe other disease-modifying drugs off-label for different types of MS.
The outlook for individuals with different types of MS varies depending on factors such as the severity of their symptoms, their response to treatment, and overall health.
The outlook for individuals with RRMS has seen a significant improvement with the use of disease-modifying drugs. These therapies can reduce the frequency of relapses and slow the progression of disability. With appropriate treatment, many people with RRMS continue to lead active, fulfilling lives.
PPMS can have a more challenging outlook due to its progression. People with PPMS also
In this section, we answer some frequently asked questions about RRMS and PPMS.
Is PPMS the worst type of MS?
Some individuals may consider PPMS to be more severe than RRMS due to its continuous progression and lack of remissions.
However, the impact of MS varies widely among individuals, and some may experience milder forms of PPMS.
Can RRMS turn into PPMS?
RRMS does not turn into PPMS, but many people with RRMS eventually transition to secondary progressive MS (SPMS), which shares characteristics with PPMS in its progressive nature.
RRMS and PPMS are two distinct types of MS, each with unique challenges and management strategies. RRMS involves relapses and remissions, while PPMS involves a gradual progression of symptoms.
Treatment approaches are similar, but for RRMS, there is a range of disease-modifying drugs that can reduce relapses. There are fewer options for treating PPMS.
Understanding the differences between these forms of MS is crucial for effective management.