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Understanding Secondary-Progressive MS

What Is SPMS?

Secondary-progressive MS (SPMS) is a form of multiple sclerosis. It’s considered to be the next stage after relapsing-remitting MS (RRMS). With SPMS, there are no longer any signs of remission. This means that the condition is worsening despite treatment. However, treatment is still necessary to help ease your symptoms and treat attacks.

The condition is common. In fact, most MS patients will develop SPMS at some point. But if you know its signs and detect SPMS early, your doctor will be better able to help you manage the symptoms.

How Relapsing-Remitting MS Becomes SPMS

MS is a progressive autoimmune disease that comes in different forms and affects patients differently. According to Johns Hopkins Medicine, about 90 percent of all patients have RRMS. This is the earliest stage of MS.

In this stage, patients first begin to notice symptoms such as:

  • numbness or tingling
  • incontinence (bladder control problems)
  • changes in vision
  • walking difficulties
  • excessive fatigue

Unlike other types of chronic diseases, RRMS symptoms can come and go. Patients might not experience any symptoms for several weeks or months, a phenomenon called remission. Then the MS symptoms can come back without warning. This is called an attack, or relapse.

A relapse can happen for a few hours or several days, and the symptoms can gradually worsen. RRMS is so unpredictable that some patients transition into remission without treatment.

At some point, many people with RRMS no longer experience periods of remission or sudden relapses. Instead, MS symptoms continue and worsen without any break. Continued, worsening symptoms set SPMS apart from RRMS.

Ongoing Symptoms Without Remission

Similar symptoms exist within all forms of MS. But SPMS symptoms are far worse than RRMS. During the early stages of RRMS, symptoms are noticeable, but they aren’t necessarily severe enough to interfere with your everyday activities. Once MS progresses to the secondary-progressive stage, symptoms become more grueling.

SPMS develops as a result of worsening inflammation. If you notice your symptoms becoming worse without any remission or noticeable relapses, your doctor will likely test for SPMS. A magnetic resonance imaging (MRI) scan may aid in the diagnosis. MRI scans can detect the level of inflammation in the brain. Generally, swelling will decrease during remission, but then increase again during a relapse. In SPMS, the level of inflammation does not decrease.

Treating SPMS

SPMS is marked by the absence of relapses, but it’s still possible to have an attack of symptoms. When this happens, your symptoms are worse than they were during RRMS.

To prevent attacks in RRMS, your doctor may prescribe an interferon beta medication, such as dimethyl fumarate, natalizumab, or teriflunomide. But these medications are designed for treating relapses, which do not occur in SPMS. If you were using one of these drugs in treating your RRMS, your doctor may switch you to mitoxantrone. This is the only drug used to treat SPMS.

Aside from medications, other treatment measures can help improve symptoms and quality of life. These include:

  • physical therapy
  • occupational therapy
  • regular, moderate exercise
  • cognitive rehabilitation

Outlook for SPMS

It’s important to treat MS in order to manage your symptoms. Detecting and treating RRMS early can help prevent the onset of SPMS, but there is still no definitive method for preventing the disease’s progression. The National Multiple Sclerosis Society estimates that 90 percent of RRMS patients will eventually develop SPMS within 25 years of the initial diagnosis. Fifty percent will develop SPMS within 10 years.

Though the disease will progress, it’s important to treat SPMS as early as possible. There is no cure for MS, but medical treatments can significantly improve your quality of life. If you currently have RRMS and notice worsening symptoms, it’s time to talk to your doctor. 

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