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Providing Evidence-based Oral Health Care to Individuals Diagnosed with Degenerative Disorders, Part 1: Multiple Sclerosis
Courses of Disease

Course Author(s): Melanie Simmer-Beck, RDH, PhD

Courses of Disease

The course of MS and symptoms are dependent upon the type of MS and where the lesions, within the central nervous system, are located. Disease patterns can vary from a benign illness to a progressive, debilitating disease. Disease patterns have been categorized into four courses of disease.29-31 These are summarized in Table 2.

Table 2. Multiple Sclerosis Disease Characterizations
Clinical Course of DiseaseTypical Disease Patterns

Relapsing/Remitting (RRMS)

  • The most common form of MS.
  • Disease onset is characterized by clearly defined sporadic acute attacks of worsening condition (referred to as relapses or exacerbations).
  • Symptoms can persist from days to weeks and then spontaneously resolve (remission).
  • Remission typically concludes with a full recovery; however, occasionally residual deficits will remain.
  • The disease does not progress during periods of remission.

Primary Progressive (PPMS)

  • Disease onset is progresses slowly with neurologic function steadily declining.
  • Individuals do not have acute attacks.
  • Onset is generally at a later age.

Secondary Progressive (SPMS)

  • A clinical course of disease advancing from RRMS to a progressive deterioration with or without occasional relapses, minor remissions, and/or plateaus.
  • Causes the greatest amount of neurological disability.

Progressive/Relapsing

  • Disease onset is progressive with clear acute relapses and progression continues during the periods between disease relapses.
  • Full recovery is unpredictable.
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