The change can happen soon after MS symptoms appear, or it can take years or decades. About 15% of people with multiple sclerosis have this form, but it's the most common type in people diagnosed after age 40. In primary progressive multiple sclerosis, symptoms gradually worsen and accumulate over several years, and there are no periods of remission, although people usually have periods when the disease seems to stabilize. Some people's symptoms come and get worse over time, while for others, they come and go.
Periods when symptoms worsen are known as relapses. Periods when symptoms improve or go away are known as remissions. Relapsing-remitting multiple sclerosis is characterized by relapses that last at least 24 hours. During a relapse, symptoms worsen.
A relapse will be followed by a remission. During a remission, the symptoms partially or completely disappear. For example, pain that is just as intense during the day can keep MS patients awake at night and worsen other symptoms due to lack of sleep. If you think you're having a relapse and your symptoms are mild, you can choose to wait and see if they improve.
Damage can occur in a part of the central nervous system that doesn't cause symptoms, or the brain can adapt quickly and redirect messages around an area of inflammation. Sometimes, an infection can cause an exacerbation of symptoms rather than a relapse, so the nurse or family doctor will look at other possible causes. Keeping track of the symptoms of multiple sclerosis in a symptom log or diary can help identify patterns and trends about when specific symptoms worsen. This is because many symptoms of multiple sclerosis can fluctuate from day to day, so the changes may be part of the daily pattern of ups and downs of multiple sclerosis and not be the beginning of a relapse.
In about 1 in 4 cases of multiple sclerosis, the first visible symptom is a problem in one of the eyes (optic neuritis). Relapsing remitting multiple sclerosis is a long-term health condition that involves periods when symptoms worsen, followed by remission. Finding patterns can help identify what can be adjusted to improve symptoms or prevent them from getting worse. In addition, some symptoms don't necessarily worsen at night, but rather present unique challenges because they interfere with sleep.
However, there are certain symptoms that tend to improve or worsen at night compared to during the day. It's important for each person to find what best suits their needs, their abilities and preferences, and their symptoms. Depending on the type of multiple sclerosis you have, your symptoms may come and go in phases or get steadily worse over time (progress). Your multiple sclerosis nurse will ask you about your symptoms, when they started, what has changed, and how these symptoms affect you on a daily basis.
A person with relapsing, remitting multiple sclerosis will have episodes of new or worsening symptoms, known as relapses. Whether you decide to take steroids or not, there may be other treatments that can help relieve your symptoms.