Secondary-progressive multiple sclerosis (SPMS) is a form of multiple sclerosis. It’s considered 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 recommended at times to help reduce attacks and hopefully slow the progression of disability.
This stage is common. In fact, most people with MS will develop SPMS at some point if not on an effective disease-modifying therapy (DMT). Knowing the signs of SPMS can help you detect it early. The sooner your treatment starts, the better your doctor will be able to help you reduce new symptoms and worsening of your disease.
MS is a chronic autoimmune disease that comes in different forms and affects people differently. According to Johns Hopkins Medicine, about 90 percent of those with MS are initially diagnosed with RRMS.
In the RRMS stage, the first noticeable symptoms include:
- numbness or tingling
- incontinence (bladder control problems)
- changes in vision
- walking difficulties
- excessive fatigue
RRMS symptoms can come and go. Some people might not have any symptoms for several weeks or months, a phenomenon called remission. MS symptoms can come back, too, though this is called a flare-up. People can also develop new symptoms. This is called an attack, or relapse.
A relapse typically lasts for several days to several weeks. The symptoms can gradually worsen initially and then improve gradually over time without treatment or sooner with IV steroids. RRMS is unpredictable.
At some point, many people with RRMS no longer have periods of remission or sudden relapses. Instead, their MS symptoms continue and worsen without any break.
Continued, worsening symptoms indicate that RRMS has progressed to SPMS. This usually occurs 10 to 15 years after the first MS symptoms. However, SPMS can be delayed or even possibly prevented if started on effective MS DMTs early on in the disease course.
Similar symptoms exist within all forms of MS. But SPMS symptoms are progressive and don’t improve over time.
During the early stages of RRMS, symptoms are noticeable, but they aren’t necessarily severe enough to interfere with everyday activities. Once MS progresses to the secondary-progressive stage, symptoms become more challenging.
SPMS develops as a result of neuronal loss and atrophy. If you notice your symptoms becoming worse without any remission or noticeable relapse, an MRI scan may aid in the diagnosis.
MRI scans can show the level of cell death and brain atrophy. An MRI will show increased contrast during an attack because leaking of the capillaries during an attack causes a greater uptake of the gadolinium dye used in MRI scans.
SPMS is marked by the absence of relapses, but it’s still possible to have an attack of symptoms, also known as a flare-up. Flare-ups are usually worse in heat and during times of stress.
Currently, there are 14 DMTs used for relapsing forms of MS, including SPMS that continues to have relapses. If you were taking one of these drugs to treat RRMS, your doctor may have you on it until it stops controlling disease activity.
Other types of treatment can help improve symptoms and quality of life. These include:
- physical therapy
- occupational therapy
- regular moderate exercise
- cognitive rehabilitation
Clinical trials test new types of medicine and therapies on volunteers in order to improve treatment for SPMS. This process gives researchers a clearer sense of what’s effective and safe.
Volunteers in clinical trials may be among the first to get new treatments, but some risk is involved. The treatments may not help with SPMS, and in some cases, they may come with serious side effects.
Importantly, precautions should be in place to keep volunteers safe, as well as protect their personal information.
Participants in clinical trials generally need to meet certain guidelines. When deciding whether to take part, it’s important to ask questions like how long the trial will last, what the potential side effects might include, and why researchers think it’ll help.
The National Multiple Sclerosis Society website lists clinical trials in the United States, though the COVID-19 pandemic may have delayed planned studies.
Clinical trials currently listed as recruiting include one for simvastatin, which may slow the progression of SPMS, as well as research into whether different types of therapy can help people with MS manage pain.
Another trial aims to test whether lipoic acid can help people with progressive MS stay mobile and protect the brain.
And a clinical trial is set to finish later this year of NurOwn cells. Its goal is to test the safety and efficacy of stem cell treatment in people with progressive MS.
Progression refers to symptoms becoming measurably worse over time. At some points, SPMS may be described as “without progression,” meaning it doesn’t seem to be measurably worsening.
Progression varies considerably among people with SPMS. In time, some may need to use a wheelchair, but many people remain able to walk, possibly using a cane or walker.
Modifiers are terms that indicate whether your SPMS is active or inactive. This helps inform conversations with your doctor about possible treatments and what you can expect going forward.
For example, in the case of SPMS that’s active, you might discuss new treatment options. In contrast, with absent activity, you and your doctor may discuss using rehabilitation and ways to manage your symptoms with possibly a DMT that has less risk.
The average life expectancy for people with MS tends to be about 7 years shorter than the general population. It’s not entirely clear why.
Apart from severe cases of MS, which are rare, the main causes seem to be other medical conditions that also affect people generally, like cancer and heart and lung disease.
Importantly, life expectancy for people with MS has increased in recent decades.
It’s important to treat MS in order to manage symptoms and decrease disability worsening. Detecting and treating RRMS early can help prevent the onset of SPMS, but there’s still no cure.
Though the disease will progress, it’s important to treat SPMS as early as possible. There’s no cure, but MS isn’t fatal, and medical treatments can significantly improve quality of life. If you have RRMS and are noticing worsening symptoms, it’s time to talk to your doctor.