Progressive-Relapsing MS (PRMS)
Overview
Multiple Sclerosis (MS) is a disease of the central nervous system, which is comprised of the brain, spinal cord and optic nerve. This disorder causes destruction of the coating (myelin) that surrounds and protects nerve fibers (axons). As a result, the damage disrupts the normal flow of messages (nerve impulses) from the central nervous system, causing a reduction or loss of body function. In many cases, the nerve fibers are also destroyed.
Progressive-relapsing multiple sclerosis (PRMS) is the least common form of the disease.
The condition is characterized by a progressive worsening of the condition from the beginning, similar to primary-progressive multiple sclerosis (PPMS). There are occasional relapse episodes of intensified symptoms similar to those experienced by relapsing-remitting MS (RRMS).
The progressive worsening of the condition in PRMS is caused by nerve damage or loss, while the relapse episodes are due to inflammation.
Symptoms
Symptoms of primary-relapsing multiple sclerosis are similar to those of the primary-progressive variant of the disease. The main symptom of both forms of the condition is a gradual worsening of disability.
This may be experienced through increased:
- Fatigue
- Numbness or tingling
- Vision problems, such as double vision
- Spasticity or stiffness of the muscles
- Difficulty controlling the bladder or bowels
- Problems with cognition, such as learning and memory or information processing
- Difficulty with walking and coordination
- Muscle weakness
- Paralysis
- Dizziness
- Shakiness
- Mood changes
- Depression
- Sexual dysfunction
Causes and Risk Factors
Only 5 percent of all multiple sclerosis patients are diagnosed with PRMS, and its cause is unknown.
Since the risk of multiple sclerosis is significantly higher when a parent has been diagnosed with the disease, genetic factors may play a role. The unusual relationship between a person's geographic location during childhood and the risk of MS later in life suggests there may be environmental factors at work in the disease.
Patients with PRMS tend to be diagnosed in their mid-to-late 30s, and the condition affects men and women equally.
Diagnosis
Diagnosis begins with a detailed medical history and neurological examination. Because multiple sclerosis can have symptoms similar to those of other nervous system disorders, diagnostic tests will help rule out other causes and confirm a diagnosis.
These tests may include a magnetic resonance imaging (MRI) scan of the brain and spinal cord. The patient's medical team may order a lumbar puncture, also known as a spinal tap, and cerebrospinal fluid analysis, as well as nerve function tests. Blood tests may be performed to rule out other conditions that have similar symptoms.
PRMS is often initially diagnosed as PPMS. The diagnosis is then modified once a pattern of relapse episodes along with the progressive decline of neurological function is observed. The only definitive way to diagnose PPMS apart from other forms of the disease is by observation.
In order to confirm a diagnosis of PPMS, the patient must:
- Have a year of progression of the condition including worsening neurologic function
- Meet two of the following criteria:
- A type of lesion in the brain that is recognized by experts in as being typical of multiple sclerosis
- Two or more lesions of a similar type in the spinal cord
- Evidence in the spinal fluid of oligoclonal band or an elevated IgG index, both of which are indicative of immune system activity in the central nervous system
Treatments
There is no cure for PRMS, but it is not classified as a fatal disease. Symptoms associated with relapse episodes may be managed with corticosteroids, which can shorten and lessen the severity of the relapse. Symptoms of PRMS can affect a patient's daily life and physical and occupational therapy may be used to manage symptoms and adjust patients to living and working situations.
Certain medications may be used to reduce the frequency and severity of relapse episodes. Interferon beta medications have been approved by the FDA to treat relapsing-remitting forms of multiple sclerosis, including PRMS. These medications are injected into the muscle and aid in reducing inflammation.
Other medications may address specific symptoms such as:
- Depression
- Muscle spasms
- Need for frequent urination
- Erectile dysfunction
Choosing the right medication requires careful consideration of the risks and benefits, along with close collaboration with an experienced neurologist with experience in treating the disease, such as those at the Multiple Sclerosis Center in Cedars-Sinai's Department of Neurology.
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