Table of ContentsView AllTable of ContentsOnsetSigns and SymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Onset
Signs and Symptoms
Causes
Diagnosis
Treatment
Maybe you’ve just been diagnosed with secondary progressive MS (SPMS). Or maybe you’re one of the 85% to 90% of people withmultiple sclerosis (MS)who are initially diagnosed with relapsing-remitting MS (RRMS) and you’re not sure how your healthcare provider will know when (or if) it transitions to secondary progressive MS (SPMS). Either way, it’s good to understand how the disease can progress so you can be prepared for the future.
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However, since the development of disease-modifying therapies, the progression to secondary MS has become less frequently noted.
You can go from having RRMS to SPMS at any time, but the process is gradual and, in most patients, slow. In fact, there’s often a gray zone between RRMS and SPMS when you’re moving into the progressive phase of MS but are still having occasional MS relapses.
Types of MS
There aren’t any guidelines or criteria that define when you move from RRMS to SPMS, but here are some signs that you and your healthcare provider may look for when determining whether this transition is occurring or has already occurred.
Your Medications Don’t Work Well
Sometimes, despite your best efforts andadherenceto taking your disease-modifying medication, you may begin to show increasing disability without a corresponding increase in the number of lesions on yourmagnetic resonance imaging (MRI)scans. This could be an indication that you’re moving into SPMS.
Some people may worry that they’re entering the progressive phase of MS because they stop having relapses. However, if your neurological exam is stable, this is a verygoodsign, as it means that your disease-modifying treatment is working.
Your Relapses Are Changing
The natural course of RRMS is for the number of relapses you have to actually decrease over time. However, the relapses that do occur may be more severe, bringing multiple symptoms, rather than just affecting one area of function.
Recovery from these relapses also tends to be incomplete, meaning that even after the acute phase of the relapse has passed, you still have some symptoms and/or disability. Additionally, you no longer respond as well toSolu-Medrolduring these relapses.
Understanding MS Relapses
There’s a Large Amount of Damage Seen on MRI
When you have an MRI, you and your healthcare provider may see these results:
Greater Lesion Burden
This means that there’s a greater total number of lesions, which tend to be:
More Axonal Damage and “Black Holes"
Areas that show up as dark (hypointense) spots on a T1 scan are referred to as “black holes.” These are areas where there has been repeated inflammation, leading to complete destruction of both myelin and the axons themselves. These areas strongly correlate with disability.
Enlargement of CSF-Filled Ventricles in the Brain
This is a measure ofatrophy. As there is less brain tissue, the spaces around and within the brain get bigger.
A Decrease in Gadolinium-Enhancing Lesions
Paradoxically, the number of new, activegadolinium-enhancing lesionsdecreases in later stages of RRMS. This is because the disease is most likely becoming more degenerative than inflammatory.
Everything You Need to Know About MRI for MS
You Have a Greater Degree of Disability
Your healthcare provider will also find more abnormalities during your neurological exam. This shows that your brain can no longer compensate for the demyelination—your immune system’s attacks on themyelin sheath, the protective covering around nerve fibers.
Lastly, people that develop SPMS tend to exhibit more cognitive impairment. This is most likely due to the greater degree of atrophy in the brain, which is highly correlated tocognitive dysfunction. What this really means is that your brain can’t offset the damage anymore, especially where there’s complete axonal (nerve fiber) destruction, resulting in black holes.
Understanding the Expanded Disability Status Scale (EDSS)
As with all types of MS, no one knows what causes SPMS. It’s believed to be a combination of factors involving genetics and environmental triggers like infections, vitamin D deficiency, geography, and childhood obesity.
In terms of factors that may influence the transition from RRMS to SPMS, studies show that men appear to develop SPMS more quickly and at a younger age than women. However, both genders end up needing to use a cane at around the same age, so even though they may enter the progressive phase earlier, males don’t have a worse outcome.
Smoking has also been found to increase your risk of transitioning from RRMS to SPMS.
What Causes Multiple Sclerosis?
If you’ve already been diagnosed with RRMS, you probably know that the diagnostic process can be a time-consuming process as your healthcare provider performs tests, rules out other conditions, and puts together pieces of the diagnostic puzzle.
Similarly, diagnosing SPMS requires a combination of strategies, including a thorough neurological examination and repeat MRIs. As with RRMS, there are no definitive diagnostic tests.
When it comes to diagnosing SPMS, your practitioner will need to confirm two facts:
Changes in SPMS
In RRMS, inflammatory processes cause demyelination. This inflammation can be seen on your MRIs during relapses in the form of bright white spots (gadolinium-enhancing lesions).
However, in SPMS, there’s less inflammation and more degeneration of gray matter and white matter, as well as spinal cord atrophy (nerve damage and loss), which can also be seen on MRI. While there’s still demyelination and inflammation happening, it’s more widespread.
Spinal cord atrophy is far more prominent in SPMS than it is in RRMS too, and this nerve loss can cause bowel and bladder problems, along with more difficulty walking.
While you experienced relapses in RRMS, these will become less and less frequent. Instead, you’ll notice that your condition is gradually worsening. For instance, you might be able to tell that it has gotten harder to walk for the last several months, but you can’t pinpoint a time when it suddenly got worse.
The Transition PeriodThere’s often a transition period between when RRMS ends and SPMS begins. This can make it tricky to tell exactly what’s going on because there’s overlap between the two types. As your MS progressively worsens, you may still have an occasional relapse.
The Transition Period
There’s often a transition period between when RRMS ends and SPMS begins. This can make it tricky to tell exactly what’s going on because there’s overlap between the two types. As your MS progressively worsens, you may still have an occasional relapse.
Disease Modifiers
SPMS can also be classified throughout the course of the disease as active, not active, and with or without progression.
So, for instance, if your SPMS is classified asnot active without progression, it’s stable. If it’sactive without progression, you’ve had relapses and/or new MRI activity, but there’s no evidence of worsening disability.
Like RRMS, SPMS symptoms are highly variable, and so is the rate at which it progresses. Every situation is different; some people become more disabled more quickly than others.
Steps to Getting an MS Diagnosis
Symptomatic Treatment of SPMS is similar to that of RRMS, though progressive forms of MS are notoriously more difficult to treat.
Rehabilitation Therapies
If your MS is progressing, your neurologist will likely review your rehabilitation interventions with you to see if you need any adjustments or additions. These treatments, which include physical therapy, occupational therapy, speech-language therapy, and cognitive rehabilitation, can help you function at your best and maintain your muscle strength and mobility.
Drug-Modifying Therapies
Other types of drugs that may be used include monoclonal antibodies, such as Briumvi (ublituximab), Rituxan (rituximab), and Tysabri (natalizumab),andtype II topoisomerase inhibitors, such as mitoxantrone, glucocorticoids, and cyclophosphamide.
In rare cases, a stem cell transplant may be an option.
How Multiple Sclerosis Is Treated
Symptom Management
Managing your individual symptoms is an important part of your care too, especially as you transition to SPMS. Your healthcare provider may prescribe some different or additional medications to help with MS-related symptoms such as:
Emotional and Psychological Symptoms in MS
A Word From Verywell
Even though the treatment for SPMS is currently suboptimal, feel reassured that there are many ongoing research studies trying to come up with treatments that will hopefully stop the progression of this disease as well as improve disability.
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3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Multiple Sclerosis Society.Diagnosing SPMS.Olek MJ, Howard J.Clinical Presentation, Course, and Prognosis of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Mowry E.Treatment of Progressive Multiple Sclerosis in Adults. UpToDate.Additional ReadingOlek MJ, Howard J.Evaluation and Diagnosis of Multiple Sclerosis in Adults. UpToDate.Ontaneda D, Fox RJ.Progressive Multiple Sclerosis.Current Opinions in Neurology. 2015;28(3):237–243. doi:10.1097/WCO.0000000000000195.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Multiple Sclerosis Society.Diagnosing SPMS.Olek MJ, Howard J.Clinical Presentation, Course, and Prognosis of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Mowry E.Treatment of Progressive Multiple Sclerosis in Adults. UpToDate.Additional ReadingOlek MJ, Howard J.Evaluation and Diagnosis of Multiple Sclerosis in Adults. UpToDate.Ontaneda D, Fox RJ.Progressive Multiple Sclerosis.Current Opinions in Neurology. 2015;28(3):237–243. doi:10.1097/WCO.0000000000000195.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Multiple Sclerosis Society.Diagnosing SPMS.Olek MJ, Howard J.Clinical Presentation, Course, and Prognosis of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Mowry E.Treatment of Progressive Multiple Sclerosis in Adults. UpToDate.
National Multiple Sclerosis Society.Diagnosing SPMS.
Olek MJ, Howard J.Clinical Presentation, Course, and Prognosis of Multiple Sclerosis in Adults. UpToDate.
Olek MJ, Mowry E.Treatment of Progressive Multiple Sclerosis in Adults. UpToDate.
Olek MJ, Howard J.Evaluation and Diagnosis of Multiple Sclerosis in Adults. UpToDate.Ontaneda D, Fox RJ.Progressive Multiple Sclerosis.Current Opinions in Neurology. 2015;28(3):237–243. doi:10.1097/WCO.0000000000000195.
Olek MJ, Howard J.Evaluation and Diagnosis of Multiple Sclerosis in Adults. UpToDate.
Ontaneda D, Fox RJ.Progressive Multiple Sclerosis.Current Opinions in Neurology. 2015;28(3):237–243. doi:10.1097/WCO.0000000000000195.
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