What is Secondary-Progressive Multiple Sclerosis & How is it Treated? | Who is Like to Get Secondary-Progressive Multiple Sclerosis?

What is Secondary Progressive Multiple Sclerosis?

There are four types of multiple sclerosis. Secondary Progressive Multiple Sclerosis (SPMS) is a type of multiple sclerosis that is usually the second stage after relapsing-remitting multiple sclerosis.(1,2) According to the National Multiple Sclerosis Society, most people have relapsing-remitting multiple sclerosis as the first stage and eventually move on to a secondary progression of the disease that involves a slow worsening of their symptoms over time.(3) When you enter the stage of secondary progressive multiple sclerosis, you may no longer experience any signs of remissions. This is an indication that your condition is getting worse despite treatment.(4) However, this does not mean that you will stop your treatment. Your treatment will still continue as it will help reduce the intensity of your symptoms and to slow down the progression of disability commonly associated with multiple sclerosis.(5,6)

When you are at the first stage of multiple sclerosis, you are likely to experience alternating periods of relapse followed by remission. However, with secondary progressive multiple sclerosis, you are unlikely to notice any significant symptom changes.(7) On the other hand, you may even feel like your symptoms never truly go away and are gradually worsening. You may also experience flare-ups, though it is less likely.

Secondary progressive multiple sclerosis is further classified into two stages:

  1. Active Secondary Progressive Multiple Sclerosis: During which a person experience relapses or some evidence of new disease activity that is visible in an MRI scan. Non-active means there has been no evidence of any new activity.(8)
  2. Secondary Progressive Multiple Sclerosis with Progression: This occurs when a person experiences a gradual worsening of their symptoms. Secondary progressive Multiple Sclerosis without progression means that there is no evidence of the symptoms getting worse.(9)

Usually, the changes between relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis are hard to spot even by doctors as this shift happens very slowly. However, people with secondary progressive multiple sclerosis may experience a change in their symptoms due to a change in inflammation. Nevertheless, the disease does tend to progress steadily, but slowly, and cause nerve damage or even complete nerve loss over a period of time.

People with multiple sclerosis who are not on an effective disease-modifying therapy (DMT) are more prone to develop secondary progressive multiple sclerosis.(10) At this stage, doctors will offer specifically tailored treatments for managing the severe symptoms and also to slow down the progression of the disease. Remember that since there is no cure for multiple sclerosis, it is essential that you seek treatment for managing the symptoms and controlling the progression of the disease.

How Does Relapsing-Remitting MS Progress into Secondary Progressive MS?

Multiple sclerosis is a chronic autoimmune disorder that affects people in different forms and ways. According to estimates from John Hopkins Medicine, nearly 90 percent of people with multiple sclerosis are initially diagnosed with relapsing-remitting multiple sclerosis.(11)

During the initial relapsing-remitting multiple sclerosis stage, the first symptoms that a person usually notices include:

The symptoms of this stage continue to come and go. Some people may not experience any symptoms for many weeks or months, a phase that is known as remission. Once the symptoms of the disease come back, usually slightly worse than before, it is known as a flare-up. Some people also develop new symptoms, which is known as a relapse or an attack of multiple sclerosis. A relapse can last for several days to a couple of weeks. During this time, the symptoms can tend to worsen initially and then improve gradually without needing treatment. You can opt for getting intravenous steroids if you want to recover faster from your symptoms. The stage of relapsing-remitting multiple sclerosis is very unpredictable.(12)

At some point, though, most people with the initial stage of the disease no longer experience periods of remission or any sudden relapses. Instead, they find that their symptoms are continuing and may even worsen without any break in between. This continued worsening of symptoms is usually an indication that the disorder has progressed from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. This shift can take at least 10 to 15 years from the onset of your first multiple sclerosis symptoms. However, in many cases, the change to secondary progressive multiple sclerosis can be delayed or even prevented if you were put on an effective delayed modified therapy at an early stage of the disease itself.(13)

Who Is Likely To Get Secondary Progressive Multiple Sclerosis?

Secondary progressive multiple sclerosis is considered to be the second stage of relapsing-remitting multiple sclerosis. While it may take several years for a person to shift to the second stage, but the course of progression is different for everyone, and it is very challenging to predict this shift.

According to the National Multiple Sclerosis Society, before the advent of modern treatments, nearly 50 percent of all people with relapsing-remitting multiple sclerosis would go on to develop the second stage within ten years, while 90 percent would make the shift in 25 years.(3) However, with the present variety of treatments and medication, the time period has dramatically changed for treating multiple sclerosis, though it is still too early to determine precisely how shifting to new drugs can affect this progression to secondary progressive multiple sclerosis.

There is no known direct cause of this shift between relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. Some doctors are of the opinion that the time period between the shift to a more advanced stage is due to damage caused in the early stages of the condition. The earlier you start treatment for multiple sclerosis, the better are your chances of delaying progression to secondary progressive multiple sclerosis.

Diagnosis and Treatment of Secondary Progressive Multiple Sclerosis

Secondary progressive multiple sclerosis develops due to atrophy and neuronal loss. If you find your symptoms are getting worse without any noticeable period of relapse or any remission, your doctor is likely to order an MRI scan to diagnose the shift in staging.(14)

MRI scan can indicate the level of brain atrophy and cell death. It will also show a higher contrast during an attack because, during an attack, the leaking of the capillaries leads to a higher uptake of the dye used in the MRI scans.(15)

Secondary progressive multiple sclerosis is characterized by a notable absence of relapses. However, it is still possible to experience a flare-up, especially during the summer months, and if you are stressed.

At present, there are 14 disease-modifying therapies that are used to treat relapsing forms of multiple sclerosis, including secondary progressive multiple sclerosis. If you have been taking one of these medications for treating relapsing-remitting multiple sclerosis, your doctor may keep you on it until the drug is no longer able to control the disease activity.

Some other types of treatment can help improve your symptoms and overall quality of life. These include:(16)

Conclusion: Outlook for Secondary Progressive Multiple Sclerosis

The average life expectancy for people with multiple sclerosis is around seven years less than the general population, though the reason behind this is not clear.(17)

It is essential to treat multiple sclerosis, the earlier the better, in order to manage your symptoms and also to slow down the progression of the disease, which can decrease disability worsening. Detecting and treating relapsing-remitting multiple sclerosis at an early stage can help prevent the disease from progressing to secondary progressive multiple sclerosis, but there is no cure for this condition.

Even though the disease will continue progressing, it is still important to treat secondary progressive multiple sclerosis as soon as possible. While multiple sclerosis is not life-threatening, getting treatment at the right time can help you dramatically improve the quality of your life.

References:

  1. Thompson, A.J., Kermode, A.G., Wicks, D., MacManus, D.G., Kendall, B.E., Kingsley, D.P.E. and McDonald, W.I., 1991. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 29(1), pp.53-62.
  2. Prineas, J.W., Kwon, E.E., Cho, E.S., Sharer, L.R., Barnett, M.H., Oleszak, E.L., Hoffman, B. and Morgan, B.P., 2001. Immunopathology of secondary‐progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 50(5), pp.646-657.
  3. National Multiple Sclerosis Society. 2020. Secondary Progressive MS (SPMS). [online] Available at: <https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS> [Accessed 3 November 2020].
  4. Rovaris, M., Confavreux, C., Furlan, R., Kappos, L., Comi, G. and Filippi, M., 2006. Secondary progressive multiple sclerosis: current knowledge and future challenges. The Lancet Neurology, 5(4), pp.343-354.
  5. Tremlett, H., Zhao, Y. and Devonshire, V., 2008. Natural history of secondary-progressive multiple sclerosis. Multiple Sclerosis Journal, 14(3), pp.314-324.
  6. Beiske, A.G., Naess, H., Aarseth, J.H., Andersen, O., Elovaara, I., Farkkila, M., Hansen, H.J., Mellgren, S.I., Sandberg-Wollheim, M., Sorensen, P.S. and Myhr, K.M., 2007. Health-related quality of life in secondary progressive multiple sclerosis. Multiple Sclerosis Journal, 13(3), pp.386-392.
  7. Thompson, A.J., Kermode, A.G., Wicks, D., MacManus, D.G., Kendall, B.E., Kingsley, D.P.E. and McDonald, W.I., 1991. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 29(1), pp.53-62.
  8. Wiendl, H., Kieseier, B.C., Weissert, R., Mylius, H.A., Pichlmeier, U., Hartung, H.P., Melms, A., Kuker, W. and Weller, M., 2007. Treatment of active secondary progressive multiple sclerosis with treosulfan. Journal of neurology, 254(7), p.884.
  9. Vukusic, S. and Confavreux, C., 2003. Prognostic factors for progression of disability in the secondary progressive phase of multiple sclerosis. Journal of the neurological sciences, 206(2), pp.135-137.
  10. Brown, J.W.L., Coles, A., Horakova, D., Havrdova, E., Izquierdo, G., Prat, A., Girard, M., Duquette, P., Trojano, M., Lugaresi, A. and Bergamaschi, R., 2019. Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis. Jama, 321(2), pp.175-187.
  11. McNamara, L., 2020. What Is Multiple Sclerosis (MS)? | The Johns Hopkins Multiple Sclerosis Center. [online] Hopkinsmedicine.org. Available at: <http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/multiple_sclerosis/conditions/> [Accessed 3 November 2020].
  12. Ziemssen, T., Tolley, C., Bennett, B., Kilgariff, S., Jones, E., Pike, J., Tomic, D., Piani-Meier, D. and Lahoz, R., 2020. A mixed methods approach towards understanding key disease characteristics associated with the progression from RRMS to SPMS: Physicians’ and patients’ views. Multiple Sclerosis and Related Disorders, 38, p.101861.
  13. Frohman, E., Phillips, T., Kokel, K., Van Pelt, J., O’Leary, S., Gross, S., Hawker, K. and Racke, M., 2002. Disease-modifying therapy in multiple sclerosis: strategies for optimizing management. The neurologist, 8(4), pp.227-236.
  14. Katz Sand, I., Krieger, S., Farrell, C. and Miller, A.E., 2014. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis. Multiple Sclerosis Journal, 20(12), pp.1654-1657.
  15. Montalban, X., Tintore, M., Swanton, J., Barkhof, F., Fazekas, F., Filippi, M., Frederiksen, J., Kappos, L., Palace, J., Polman, C. and Rovaris, M., 2010. MRI criteria for MS in patients with clinically isolated syndromes. Neurology, 74(5), pp.427-434.
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