What defines relapsing-remitting MS (RRMS)?

The majority of people who are diagnosed with MS will receive a diagnosis of relapsing-remitting MS. In fact, according to the National Multiple Sclerosis Society, “approximately 85% of people with MS are initially diagnosed with RRMS.”

In relapsing-remitting MS, there are flare-ups of the disease (relapses) and periods of remission when symptoms may or may not be present. In this way, some symptoms may become permanent. Relapses are acute periods where neurological functioning gets measurably worse.

Your MS treatment team, likely your neurologist, looks for activity using MRIs. They will be looking for new gadolinium-enhancing lesions or growing T2 lesions during a specific timeframe.

In addition to measuring the current relapsing-remitting MS activity, clinicians will measure your level of disability. This is used to track the status of MS.

Taken together, these measures help your treatment team evaluate the treatment plan and track the progression of the disease. Most people with RRMS will eventually transition to secondary progressive MS.

 

Symptoms of relapsing-remitting MS

Relapsing-remitting MS is generally marked by relapses that last at least 24-hours. During a relapse, the symptoms may get worse. Common symptoms of RRMS include one or more of the following:

• Sensitivity to heat
• Difficulty seeing or vision problems
• Fatigue
• Muscle weakness
• Numbness, particularly in the feet
• Memory problems
• Difficulty thinking clearly
• Depression
• Difficulty walking or balancing
• Urgently needing to urinate

Diagnosing relapsing-remitting MS

There are a variety of tests your physician may use to help diagnose RRMS. Your physician will ask you a series of questions about your symptoms; keep in mind that these questions are important in order to help rule out any other diseases, such as rheumatoid arthritis, that may cause similar symptoms.

Additionally, a clinician will also check your sense of balance, vision, and cognition. This helps in the diagnostic stage and can serve as a benchmark for future comparisons.

Finally, you will also need an MRI scan of your spine and brain. This is used to determine if there are areas of damage in your spinal cord and/or brain that may indicate you have MS.

The results of these tests, questions, symptoms, and observations are all used to determine the appropriate diagnosis.

Managing relapsing-remitting MS

NOTE: If you believe that you may have multiple sclerosis, you should bring up your concerns and begin the diagnostic process with a doctor. While there is not a cure for MS, clinicians can accurately identify the disease and develop a personalized treatment plan.

Your physician may prescribe medications to help ease muscle spasms, depression, and/or fatigue when battling RRMS. In addition to medications, the following lifestyle changes may help manage symptoms:

• Attending physical therapy
• Eating a diet low in saturated and trans fats
• Avoiding smoking
• Exercising a moderate amount
• Getting plenty of sleep
• Trying to avoid becoming overheated

Multiple Sclerosis Treatment Team

Neurologist

Typically, prior to being formally diagnosed with multiple sclerosis, you will be referred to a neurologist because of certain symptoms. Some neurologists specialize in MS, while others treat a broader range of neurological disorders.

Because of this experience and specialization, your neurologist will serve as the cornerstone of your MS treatment team. Be sure to build around a neurologist that you trust.

Neurologists are doctors that have studied the nervous system. To help measure the nervous system, neurologists may use the following tools and tests:

• Computed axial tomography (CAT) scans
• Magnetic resonance imaging (MRI)
• Ultrasounds of the head and/or neck
• Electroencephalography (EEG)
• Nerve conduction studies (NCS)
• Examination of gait
• Tests of reflexes or sensation

 

Physiatrist

Physiatrists are also known as Physical Medicine and Rehabilitation physicians. They are doctors that may have sub-specializations including brain injury, spinal cord injuries, sports medicine, and more.

Often, a physiatrist will be the leader of the rehabilitation team. The goals of working with a physiatrist is to develop a treatment plan that helps you live at your highest level possible while minimizing any limitations you may experience. These goals can be attained through the use of exercises and assistive devices.

 

Primary Care Doctor (PCP)

Your primary care doctor is focussed on your overall health. She will act as the point person or coordinator of your care team, not just your MS treatment team.

While your neurologist will likely act as the key decision maker for you MS treatment, it is useful for your PCP and neurologist to work together. MS can cause challenges throughout your body and it can be challenging to find the root cause of symptoms without a collaborative treatment team.

Occupational Therapists, Physical Therapists, & Speech/Language Pathologists

These clinicians specialize in rehabilitation to promote mobility, function, and quality of life. They can be useful for rebuilding strength and flexibility to ensure autonomy and quality of life.

An occupational therapist’s job is to find ways to make it easier for you to accomplish your day-to-day goals including tasks like cooking, eating, getting dressed, and more. An occupational therapist will work with you, your family, and your community to find clever ways to let you continue to live your own way.

If you are having a hard time managing pain or staying active, adding a physical therapist to your MS treatment team can help. Your joints will be healthier if they are active, and finding ways to keep you active is what your PT is best at.

Speech/language pathologists (S/LP) provide support and solutions for speech production to ensure clear and accurate communications. They can also help with swallowing problems to make sure that eating is safe.

 

Psychologists, Psychiatrists, Neuropsychologists, & Counselors

These doctors and counselors specialize in the study of behavior and the mind. They help support people and develop strategies to combat depression, anxiety, stress management, fear and phobia management, and more

These providers can also track and help improve cognitive changes including memory problems, attention issues, and difficulty with complex problem-solving.

Note: Psychiatrists are able to write prescriptions whereas psychologists and counselors rely on non-medicinal methods only.

Dietitians and Nutritionists

NOTE: Dietitians receive specialized training and a degree – they can either be registered dietitians (RD) or registered dietitian nutritionist (RDN). The term dietitian can only be used by those that have met the professional requirements which include a bachelor’s degree with accredited nutrition curriculum, satisfactory performance on a registration exam, and an internship at an approved facility. View additional information on the qualifications here.

The term nutritionist is NOT protected. That means that any person may call themselves a nutritionist whether they have any specialized training or not – and some accreditations are astoundingly easy to receive. To this point, Dr. Ben Goldacre was able to have his dead cat, Hettie, accredited as a professional member of the American Association of Nutritional Consultants for just $60. Because of this, it is important to research the background of any nutritional information you receive and maintain an open dialogue with your gastroenterologist and primary care physician about your health.

• Dietitians change the foods you eat to help assess, diagnose, and treat nutritional problems.
• Dietitians may establish individual health plans to meet goals and can leverage special services, including tube feedings, diets, and more.