What is RRMS? Do the symptoms come and go? Let's find out exactly what it is (Relapsing-Remitting Multiple Sclerosis)

Can you imagine waking up one morning and having symptoms like numbness on one side of your body and blurred vision, and then in a few days or weeks, all of that goes away completely. Then you have no problems for months, maybe even years. Everything goes back to normal. Then suddenly you have other symptoms, maybe even difficulty walking. We're talking about a condition that has a pattern of symptoms that come and go like this. This is what we call RRMS in medicine.

Simply put, what is RRMS?

RRMS is an abbreviation for `Relapsing-Remitting Multiple Sclerosis`. This is the most common type of `Multiple Sclerosis` (MS). In fact, about 80-85 out of every 100 people with MS have this type of `RRMS`.

Okay, now let's look at the meaning of this name.

• Relapsing: This refers to a period of time when symptoms suddenly appear or worsen. Some people also call this a `flare-up`. This period can last from a few days to a few weeks.
• Remitting: This refers to the period when the symptoms gradually subside and you return to normal, either completely or partially. You may be symptom-free during this period.

Simply put, RRMS is a condition characterized by alternating periods of symptom flare-ups and periods of symptom relief.

MS is an autoimmune condition in which our body's own immune system, the system that protects us from disease, mistakenly attacks our own central nervous system. It is important for you and your doctor to correctly identify the type of disease, RRMS, because that is how you can determine the most appropriate treatment for you.

What are the common symptoms seen in RRMS?

These symptoms do not occur in everyone the same way. They can vary greatly from person to person. Sometimes several of these symptoms can occur together. One or more of these may appear during a relapse.

While some people experience complete resolution of their symptoms, others may experience some residual symptoms. In such cases, physiotherapy, medication, or injections such as Botox®, as directed by your doctor, can help manage your symptoms.

Are there triggers that worsen symptoms?

Yes, certain things can cause your symptoms to come back or get worse. But these `triggers` don't affect everyone the same. What affects one person may not affect another.

Here are some common triggers:

• Stress: Excessive stress can be a major cause of symptoms.
• Temperature: High temperatures, fever, or even extreme cold for some people can worsen symptoms.
• Infections: Even minor infections, such as a common cold or a urinary tract infection, can cause old MS symptoms to resurface.
• Use of tobacco products: Smoking can accelerate the progression of the disease and worsen symptoms.
• Vitamin D deficiency: Research has found that low vitamin D levels also affect MS disease and its symptoms.

Why does this MS develop? What is the cause?

In fact, the exact cause of MS has not yet been discovered , but research has found that several factors may contribute to it.

Simply think of our nerves as electrical wires. These wires are surrounded by a protective sheath, like `insulation`. We call this `myelin` . This myelin sheath is what allows messages to travel quickly and accurately through the nerves.

In MS, our own immune system, the soldiers that protect us from disease, mistakenly attacks this myelin sheath. This attack damages the myelin sheath. Then the transmission of nerve messages is disrupted. Just like when the `insulation` of a wire is damaged, it `short-circuits`. That's when the symptoms we talked about earlier appear.

It is believed that environmental factors, including genetic predisposition and viral infections such as the Epstein–Barr virus, can cause the immune system to mistakenly attack in this way.

How is RRMS diagnosed?

Diagnosing MS can be challenging, as there is no single test that can confirm the diagnosis. Your doctor will analyze your symptoms, medical history, physical exam, and the results of several other tests to arrive at a diagnosis.

The tests usually performed for this are:

• MRI scan: An MRI (Magnetic Resonance Imaging) scan of the brain and spinal cord can identify areas of damage (lesions) to the myelin sheath.
• Lumbar Puncture: This involves inserting a very small needle into the spinal canal and taking a small amount of cerebrospinal fluid to check for the presence of proteins specific to MS, such as oligoclonal bands.
• Blood tests: Blood tests are done to make sure you don't have other conditions that cause symptoms similar to MS.
• OCT test: ``Optical Coherence Tomography`` is a painless test that examines the optic nerve at the back of the eye to see if it has been damaged by MS.

What are the treatments for RRMS?

Although there is no cure for RRMS yet, there are currently very effective treatments that can help you manage the disease and live a normal life.

The main goals of treatment are:

• Reducing the number of relapses.
• Reducing damage to the central nervous system.
• Delaying the onset of disabilities caused by the disease.

The drugs used for this are called disease-modifying therapies (DMTs) . These drugs can be obtained in various forms.

• Injections: Injections given under the skin or into a muscle.
• Oral medications: Medications that are taken as pills daily or on set days.
• Infusions: Medications that are given into the body through a vein, such as saline. These may be given once a month or every few months.

Things to ask your doctor

Because RRMS is a long-term condition, it's normal to have a lot of questions on your mind. When you go to see your doctor, write down these questions.

Some questions that may be helpful to ask your doctor:

• What type of MS do I have?
• What treatment would you recommend for me? Why?
• What are the side effects of that treatment?
• What do I do if my symptoms suddenly worsen (relapse)?
• How do I identify triggers that increase my symptoms?

Living with RRMS can be challenging. But remember, you are not alone. With the right treatment, lifestyle changes, and support from your medical team, you can live a very good, active life. Seeking the help of a mental health professional, if needed, can also be very helpful.