Primary progressive multiple sclerosis (PPMS) is one of the four types of multiple sclerosis (MS).

According to the National MS Society, about 15 percent of people with MS are diagnosed with PPMS. Unlike other types of MS, PPMS progresses from the start without relapse or remission. Although the disease progresses slowly and may take years to diagnose, it typically leads to problems with walking.

There’s no known cause for MS. However, many possible treatments can help with the progression of symptoms for PPMS.

Medications

Prior to 1993, there were no effective treatments for MS. Today, there are at least eight treatments approved by the U.S. Food and Drug Administration (FDA). Existing MS drugs are designed to lower inflammation and reduce the amount of relapses. PPMS, however, is caused by nerve damage and inflammation. Though there might be small periods of improvement, PPMS doesn’t have remissions and acute relapses.

Clinical trials for PPMS are also extremely time-consuming and expensive to conduct. This is because the typical relapses of other types of MS aren’t present. Instead, PPMS symptoms develop gradually and become more severe with time. Because PPMS progresses differently in every person who has it, it’s difficult for researchers to evaluate the effectiveness of a drug on the course of the disease. However, it’s a focus for research, and one new drug has received recent approval.

Ocrelizumab (Ocrevus) is a monoclonal antibody that acts on the immune system B cells and depletes them from circulation. B cells are involved in damage mediated by the immune system to the brain and spinal cord tissues in MS. Ocrelizumab has shown promise in a clinical trial to significantly reduce progression as compared to a placebo. Researchers report reducing the risk of progression of clinical disability for 24 weeks compared to placebo. Ocrelizumab was granted “breakthrough therapy designation” by the FDA for PPMS. This medication is administered by intravenous infusion every six months.

Other promising findings include a phase III trial with high-dose biotin (dosing ranging from 100 to 300 milligrams per day for 2 to 36 months) that showed improvement in visual impairment related to optic nerve injury.

Some medications can help manage the symptoms of MS, such as spasticity, bladder and bowel problems, and sexual dysfunction. These medications include:

Steroids

Intermittent steroids are normally used to control inflammation-related relapses during relapsing types of MS and may be given during the secondary progressive multiple sclerosis (SPMS) disease course. They’ve been given to people with PPMS with limited results. Many doctors won’t offer steroids to those with progressive forms of MS because there’s very little research pointing to their benefit. Steroids can cause serious side effects, such as:

  • glaucoma
  • high blood pressure
  • high blood sugar
  • weight gain
  • infection

Methotrexate (Trexall)

This drug was developed for chemotherapy and the treatment of autoimmune diseases. Studies have had mixed results about prescribing methotrexate to those with PPMS. Currently, it isn’t recommended for PPMS.

Other treatments

Aside from medications, many other treatments can help you improve the symptoms of PPMS. These treatments include occupational therapy, physical therapy, speech-language pathology, and exercise.

Occupational therapy

Occupational therapy teaches people the skills they need to improve their quality of life, both at home and at work. Therapists show people how to preserve their energy, since PPMS typically causes extreme fatigue. They also help people adjust their daily activities and chores. Therapists may suggest ways to improve or renovate homes and workplaces to make them more accessible to people with disabilities. They may also help in treating memory and cognitive problems.

Physical therapy

Physical therapy works to create specific exercise routines to help people increase their range of motion, preserve their mobility, and reduce spasticity and tremors. Physical therapists can recommend equipment to help people with PPMS get around better, such as wheelchairs, walkers, canes, and scooters.

Speech-language pathology (SLP)

Some people with PPMS have problems with their language, speech, or swallowing. Pathologists can teach people how to prepare food that’s easy to swallow, eat safely, and use feeding tubes properly. They may also recommend useful telephone aids and speech amplifiers to make communicating easier.

Exercise

Exercise routines can help reduce spasticity and maintain a range of motion. You can try yoga, swimming, stretching, and other acceptable forms of exercise. Of course, it’s always a good idea to approve any new exercise routine with your doctor.