Is Benign Multiple Sclerosis Real?

A small percentage of MS patients have very mild disease.

What is Benign Multiple Sclerosis?
What is Benign Multiple Sclerosis?. borchee/Getty Images

Benign multiple sclerosis sounds like an oxymoron, doesn't it? Well, believe it. Some people with MS live with relapsing-remitting multiple sclerosis in which few relapses occur throughout the course of their disease. These relapses tend to produce sensory symptoms, which go away and leave very little or no residual damage or disability.

What Is Benign MS? 

To diagnose benign MS, neurologists use the Expanded Disability Status Scale (EDSS), which gauges a person's degree of disability.

A low EDSS score (usually 3 or below, which equates with some disability while still being able to walk) ten or more years after a diagnosis of MS is the standard criterion for benign MS. 

By some estimations, benign MS occurs in 10 percent to 20 percent of people with MS, but it is impossible to predict at the time of diagnosis who will follow this course.

There is also much debate on the topic of exactly how to definitively diagnose benign MS, given that a patient's disease activity may change suddenly throughout the course of their disease. In fact, one 2007 study in Neurology showed that about 20 percent of patients initially diagnosed with benign MS actually progressed to requiring a cane at a 20 year followup period.

Another 2012 study in Multiple Sclerosis found that after 10 years, 81 percent of people initially diagnosed with benign MS experienced significant worsening of their cognitive function, fatigue, pain, or depression—symptoms of MS that are not evaluated in the EDSS.

In the same study, 74 percent of people with benign MS had a significant increase in the number of new or enlarging MS lesions on their MRIs, without a change in their EDSS. This means that imaging of their central nervous system showed a progression of MS, even though their physical abilities (like walking) were not affected.

So a progression of their MS would never have been known if they had not undergone MRIs.

More on the Benign MS Controversy

Overall, many neurologists and researchers do not use the term "benign MS," as there is so much controversy over the exact definition. As researchers Maria Pia Amato and Emilio Portaccio discuss in their 2012 article in Multiple Sclerosis, there are many debilitating symptoms of MS, and many of them are not factored into the definition of benign multiple sclerosis, which focuses predominantly on movement (motor) abilities of people. These less visible MS symptoms include:

These symptoms can be just as disabling (if not more) in terms of affecting a person's quality of life and ability to perform activities of living.

This all being said, some experts maintain that the data cannot be ignored—some patients do end up having minimal neurological and neuropsychiatric disability with MS, even when they have abnormal MRI findings.

A Word From Verywell

Regardless of the precise terminology, MS is a complex disease, and everyone's course and symptoms are unique.

This only emphasizes the importance of having close followup with your neurologist and remaining proactive in your MS health.

Sources:

Amato MP, Portaccio E. Truly benign multiple sclerosis is rare: let's stop fooling ourselves--yes. Mult Scler. 2012 Jan;18(1):13-4.

Correale J, Peirano I, Romano L. Benign multiple sclerosis: a new definition of this entity is needed. Mult Scler. 2012 Feb;18(2):210-8.

Savao AL, Devonshire V, Tremlett H. Longitudinal follow-up of "benign" multiple sclerosis at 20 years. Neurology. 2007 Feb 13;68(7):496-500.

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