What Is Secondary Progressive Multiple Sclerosis?
Secondary progressive multiple sclerosis (SPMS) is the second stage of this neurological condition, which affects the brain and spinal cord. After receiving a diagnosis of relapsing-remitting multiple sclerosis (RRMS), about half of all people will eventually develop SPMS.
Some people with MS go through a very long RRMS phase, never transitioning to SPMS, while others progress quickly. If you are living with MS, you may benefit from regular check-ups with your healthcare provider to monitor the progression of your disease and to catch SPMS early on.
Symptoms
Multiple sclerosis is characterized by a wide range of symptoms, which vary depending on where the lesions (areas of damage) develop along your central nervous system.
SPMS is marked by a gradual build-up of disability. The symptoms and signs of SPMS tend to be more serious and affect daily life more than the RRMS symptoms. For this reason, diagnosing SPMS can sometimes be tricky, as some symptoms can be linked to other conditions or even the normal aging process.1
Possible symptoms and signs of SPMS include:
Increasing weakness on one side of your body
Significant and persistent fatigue
Vision changes, such as double vision or blindness in one eye
Difficulty speaking or swallowing
Loss of coordination or impaired balance
Intention tremor
Spasticity or muscle rigidity
Numbness or tingling
Chronic pain
Incontinence
Difficulty thinking
Memory problems
Depression or anxiety
Causes
SPMS occurs due to the inflammation and damage of the myelin sheath that surrounds and protects the nerve fibers in the central nervous system. This includes damage to the nerve fibers themselves. As the myelin sheath is damaged, the nerve fibers are no longer able to properly transmit signals between the brain, the spinal cord, and the rest of the body.
Exactly why MS develops is unknown, but it’s thought to be related to a combination of genetic and environmental factors.
Risk Factors
Some factors that may increase the risk of developing MS include:2
Family history of MS
Certain genetic variations, including variations of human leukocyte antigen (HLA) genes
Viral or bacterial infections
A low level of vitamin D
Epstein-Barr virus infection
Being assigned female at birth
Obesity in adolescence or early adulthood
Trauma or major stressful life event
Tobacco smoking
Diagnosis
There are no specific tests to determine whether a person has transitioned from RRMS to SPMS. Instead, a diagnosis of SPMS is made based on a person's symptoms and signs, as well as the results of a physical and neurological exam.
SPMS is diagnosed after six months or more of worsening neurological function, especially in the absence of other MS relapses. Your healthcare provider will carefully review your medical history and discuss how your MS symptoms have changed over time.3
Treatment
Currently there are no therapies which can stop the progression or reverse the disability of SPMS. However, there are a number of disease-modifying therapies (DMTs) which are effective at slowing the progression of disability in relapsing remitting multiple sclerosis (RRMS) as well as SPMS.
DMTs are medications which change the course of the disease process in multiple sclerosis. It is crucial to take effective disease modifying therapy regularly to maximize your mobility and functionality.
There are 15 or more different types of DMTs, and new varieties continue to be developed. There are injectable, oral, and IV delivered DMTs. Talk with your MS doctor about which DMTs are right for you.
Rehabilitation Therapies
It is also essential to participate in rehabilitation therapies, such as physical therapy, occupational therapy, and speech therapy. These therapies can help you compensate for the effects of MS and perform everyday activities more easily.
Supportive Measures
Other supportive measures that may be helpful for people with SPMS include:
A walking aid, such as a cane or walker
A wheelchair
A scooter or motorized wheelchair
Resting when you need to
Maintaining a healthy lifestyle by eating a nutritious diet, getting enough sleep, and practicing exercises that don’t worsen symptoms
Talking to a therapist about emotional health
Joining a support group
Additional Information
Receiving a diagnosis of SPMS can be challenging. It’s important to remember that you are not alone and that many people with SPMS live full, active lives. Talk to your healthcare provider and MS support groups for helpful resources and strategies for managing your condition.