Relapsing-Remitting Multiple Sclerosis (RRMS)

Relapsing-remitting multiple sclerosis (RRMS) is found in about 85% of people diagnosed with MS and is the most common disease course. It is characterized by defined relapses and fresh or worse neurologic symptoms with periods of remission. RRMS is also characterized as active or inactive as well as worsening or not worsening, depending on the nature of progression.

In RRMS, the nerve fibers as well as protective sheath insulating the nerve fibers—called myelin—are attacked. These inflammatory attacks trigger immune cells which cause localized damage, thus giving rise to signs and symptoms characteristic of MS.

The site of damage can vary widely from one person to another, therefore the symptoms experienced by different people with MS can be very dissimilar.

RRMS symptoms

Symptoms may completely or partially disappear during remission, but disease progression is absent during these periods. Existing symptoms can be felt in a new area of the body and will usually occur for a few hours, but these symptoms can sometimes stay with the patient for a few weeks to many months.

Symptoms commonly seen in people with RRMS include:

Numbness
Fatigue
Spasticity
Vision problems
Bladder problems
Cognitive decline
Mobility

Attacks can range from mild to severe and might necessitate hospitalization, though most relapses can be managed at home with the help of healthcare professionals who specialize in MS. New symptoms may go away after an attack without leading to increased disability, or they can partially disappear and might cause an increase in disability.

Fresh lesions can be identified during MRI as part of an attack; however, new lesions may also be found during MRI when the person is not showing symptoms.

Diagnosis and treatment

Diagnosis of RRMS is confirmed once there is evidence of a minimum of two separate areas of myelin damage in the central nervous system (CNS) that have occurred at different times.

Other diseases that can cause similar symptoms should be ruled out. Damage in the CNS can be confirmed using tests such as:

Magnetic resonance imaging (MRI)
Visual evoked potential testing
Analysis of the cerebrospinal fluid

RRMS treatment focuses on 4 aspects:

Symptom management
Rehabilitation
Healthy living
- Diet
- Exercise
- Stress reduction
Modifying the course of the disease

Around 13 FDA-approved medications are available to help reduce the number of attacks and fresh lesions while slowing down the progression of disease. These drugs include:

Injectable medications: Avonex®, Copaxone®, and Rebif®
Infused medications: Lemtrada™ and Novantrone® (specifically used to treat worsening RRMS)
Oral medicines: Gilenya® and Tecfidera®

Modifiers of RRMS

Progression of disease should be monitored at regular intervals using MRI and neurologic examination so as to characterize the course of the disease and adjust treatment options accordingly.

If RRMS is active and worsening, an aggressive approach to treatment is recommended than is advisable in inactive or stable RRMS.
If symptoms are stable with treatment but MRI shows new disease activity, other treatment options that can control disease activity in a more effective manner and prevent worsening of symptoms should be considered.

RRMS: Summary

Women are 3 times more susceptible than men to RRMS, while the number of men and women affected by primary progressive MS (PPMS) are almost the same.
MRI reveals scars or lesions with numerous inflammatory cells in the brain of people with RRMS, while lesions that have less inflammatory cells are mostly found in the spinal cord of people with PPMS.
RRMS is mostly diagnosed in the 20 to 30 age group and develops into SPMS after 10 years of diagnosis, while PPMS onset is typically seen in the 40s or 50s.

References

http://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS
https://www.mssociety.org.uk/what-is-ms/types-of-ms/relapsing-remitting-rrms
https://mssociety.ca/about-ms/types