Secondary progressive multiple sclerosis is a later stage of multiple sclerosis. Instead of having symptom relapses and remissions, a person's symptoms steadily get worse over time.
Most people, but not everyone, with relapsing-remitting multiple sclerosis (RRMS) will eventually develop secondary progressive multiple sclerosis (SPMS). Because of advances in current treatment, fewer people go on to develop SPMS than before, and it takes longer to transition to SPMS.
In this article, we provide an overview of SPMS, including its classifications, symptoms, causes, treatments, and ways to manage symptoms.
Multiple sclerosis (MS) is a progressive condition that causes the immune system to mistakenly attacks the nerve cells in the central nervous system. The most common type of MS is RRMS, which is the stage before SPMS.
According to the National Multiple Sclerosis Society, most people with RRMS will eventually develop a secondary progression course that involves a gradual worsening of symptoms over time.
With RRMS, a person experiences periods of relapse and remission where symptoms get worse and then better again.
With SPMS, people do not notice symptom changes as drastically. Instead, they may feel as though their symptoms never really go away and gradually worsen. Relapses can also occur, but this is less likely.
SPMS also has two sets of further classifications or modifiers:
- Active SPMS means a person experiences relapses or evidence of new disease activity from an MRI scan. Nonactive means there is no evidence of current activity.
- SPMS with progression means a person experiences worsening symptoms over time. SPMS without progression means there is no evidence of the condition getting worse.
Doctors refer to people without activity and progression as having stable SPMS.
Doctors may find it difficult to spot changes between RRMS and SPMS as the shift happens gradually.
People with SPMS may still experience changes and symptoms due to inflammation. However, the disease tends to steadily progress and cause nerve damage or nerve loss over time.
Doctors may offer people with SPMS specific treatments to help manage symptoms and slow the progression of the disease.
It is important to treat MS to manage symptoms and control the progression of the disease, but there is no outright cure for MS.
SPMS is a secondary stage of RRMS. People tend to spend many years with RRMS before it transitions to SPMS. However, the course of the condition is different for everyone, and it is not possible to predict this change.
The National Multiple Sclerosis Society note that before modern therapies, 50% of people with RRMS would develop SPMS within 10 years, and 90% within 25 years. However, current medication has drastically changed the way doctors treat MS. It is still too early to say how the shift to new medicines affects the progression of MS as a whole.
There is still no known direct cause of a transition between RRMS and SPMS. Some doctors think it may be due to damage from early on in the condition.
The main symptom of SPMS is a general worsening of the person's overall condition. Relapses tend to be less abrupt and distinct at this stage, though symptom flareups can still occur.
The main difference from RRMS relapse is that symptoms do not completely go away in periods of remission, instead, they merely become more stable.
Most people with SPMS experience their symptoms regularly, with more or less intensity, depending on if they are having a relapse.
The course of SPMS can be unpredictable, and each person experiences the condition in a slightly different way.
Increased severity of the following signs and symptoms can indicate a transition to SPMS:
- general chronic fatigue
- weakness or stiffness in the legs
- tingling or numb sensations
- trouble with coordination
- trouble thinking or remembering events
- bladder or bowels issues
- erectile dysfunction
If a person experiences bladder or bowel problems with SPMS, these can include the constant urgent or need to urinate or incontinence.
The transition between RRMS and SPMS is usually gradual so that diagnosis may take some time. If a person notices their condition getting worse over time, and if they are experiencing fewer flares, the doctor may do tests to look for SPMS.
The doctor will ask about the severity and frequency of symptoms and flares. They will also perform neurological exams and repeated MRI scan to work out whether a person's condition has transitioned to SPMS.
Treatment for SPMS focuses on modifying the course of the disease and managing symptoms.
The National Multiple Sclerosis Society note that a person should undergo neurological scans and MRI at least once a year to monitor the course of the disease. If symptoms progress very quickly, doctors may recommend these tests more often.
Treatments for SPMS include:
People can use most of the disease-modifying drugs that the FDA have approved for RRMS for SPMS, according to their drug labels.
If these drugs no longer control symptoms correctly or sufficiently, doctors may recommend a change in therapy. Additionally, these drugs can cause side effects in some people that may be difficult to manage.
Choosing the right medication to help balance treatment effectiveness and side effects can take time and requires working directly with a doctor and following up with regular testing to monitor the effectiveness of treatment.
In addition to drugs that aim to modify the course of the disease, symptom management is also an important aspect of treating SPMS.
A number of drugs can help, depending on the types of symptoms a person is experiencing. Some drugs can relieve dizziness or bladder issues, while others may focus on treating the side effects of disease-modifying drugs.
Furthermore, most doctors will recommend the person make healthy lifestyle changes to support their body. This may include eating a healthful diet to control their weight and make them feel more vital.
Exercise may also help strengthen the body and improve range of motion in the muscles. People are usually advised to aim for exercises that raise the heart rate or help stretch and strengthen the muscles.
Some beneficial low-impact exercises include:
People can benefit from speaking to others who have experienced the transition from RRMS to SPMS.
Some may find it useful to join online communities to talk to other people with shared experiences of multiple sclerosis.
The most common type of MS is RRMS, which may eventually progress to SPMS.
A third type of MS is called primary progressive MS (PPMS). The Multiple Sclerosis Trust estimate that about 1 in 8 people who receive a diagnosis of MS have PPMS.
People with PPMS may not experience the cycle of relapse and recovery that marks other types of MS. Instead, they tend to experience symptoms that gradually get worse throughout the condition.
This is similar to SPMS, but the distinction is that people with PPMS do not experience the relapsing-remitting stage.
SPMS is a secondary stage that most people with RRMS experience eventually. There is no way of knowing if or when a person will experience this transition. Doctors may make the diagnosis by comparing older records of symptoms and test results to recent results.
In general, people with SPMS have fewer periods of relapse or remission than those with RRMS but may experience a steady worsening of their condition overall.
Doctors may recommend several therapies to try and reduce or prevent damage to the nervous system while also controlling symptoms.
There is no outright cure for SPMS, but working closely with a doctor helps many people find a treatment plan to ease their symptoms and monitor the disease or slow its progress.