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 necessary to help ease symptoms, treat attacks, and hopefully slow the progression of disability.

This stage is common. In fact, most people with MS will develop SPMS at some point. 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 manage the symptoms.

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

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. Then the MS symptoms can come back without warning. This is called an attack, or relapse.

A relapse can last for a few hours or several days. The symptoms can gradually worsen. RRMS is unpredictable. Some people go into remission without treatment.

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.

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 everyday activities. Once MS progresses to the secondary-progressive stage, symptoms become more challenging.

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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 show the level of inflammation in the brain. Generally, swelling will decrease during remission, then increase again during a relapse. In SPMS, the level of inflammation does not decrease even though symptoms may continue to worsen.

SPMS is marked by the absence of relapses, but it’s still possible to have an attack of symptoms. When this happens, symptoms are worse than they were during RRMS. Someone with stable, non-active SPMS may need less aggressive treatment than someone with active, progressive SPMS.

To prevent attacks in RRMS, your doctor may prescribe an interferon beta medication, such as:

  • dimethyl fumarate
  • natalizumab
  • teriflunomide

Currently there are 14 disease-modifying drugs 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 continue you on it until it stops controlling disease activity. The next step might be to switch you to mitoxantrone (Novantrone). That’s the only drug used to treat non-relapsing SPMS.

Side effects of mitoxantrone can include:

  • nausea
  • sudden hair loss
  • loss of menstrual cycle
  • bladder infections
  • mouth sores

Other types of treatment can help improve symptoms and quality of life. These include:

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

It’s important to treat MS in order to manage symptoms. Detecting and treating RRMS early can help prevent the onset of SPMS, but there’s still no definitive method for preventing the disease’s progression. The National Multiple Sclerosis Society estimates that 90 percent of people with RRMS will eventually develop SPMS within 25 years of the 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, but MS is not 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.

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