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Primary Progressive Multiple Sclerosis

A person with primary progressive multiple sclerosis (PPMS) may first seek medical care because of leg weakness or difficulty walking. Those are the most common symptoms of this type of MS.

PPMS steadily worsens after it first develops. Neurological disability will accumulate over time. How fast or to what degree disability develops varies for each person and can't be predicted. And in PPMS -- unlike some other types of MS -- there are no relapses or remissions.

Ten percent to 15% of people with multiple sclerosis are diagnosed with PPMS. It affects men and women equally. PPMS tends to be diagnosed later in life than other types of MS.

Because multiple sclerosis is such a complex and variable disease, diagnosing PPMS can be difficult. The diagnosis is often made several years into the disease. That's when doctors can look back and see that the disease is progressing without flare-ups.

Symptoms of Primary Progressive MS

Primary progressive multiple sclerosis largely affects the nerves of the spinal cord. So, the main symptoms often have to do with:

  • Problems with walking
  • Weak, stiff legs
  • Trouble with balance

Other common symptoms of PPMS include:

  • Problems in speech or swallowing
  • Visual problems
  • Fatigue and pain
  • Bladder and bowel difficulties

Cause of Primary Progressive MS

MS -- regardless of which type you have -- is thought to be an autoimmune disease. The body's defense system attacks the protective insulation around the nerves (called myelin) of the brain and spinal cord. This causes inflammation and nerve damage.

In PPMS, though, there is little inflammation. Instead, nerve damage dominates. Damaged nerves interrupt the transmission of nerve signals. This causes neurological symptoms.

Plaques of scar tissue or lesions may eventually form along the damaged nerves in the brain and spinal cord.

Primary Progressive MS Treatment

The drugs typically used to treat MS -- disease modifying drugs (DMDs) and steroids -- are thought to be less helpful for PPMS. These drugs work by:

  • Lessening inflammation
  • Reducing the number and severity of relapses

Because inflammation and relapses are not factors in PPMS, these medications are not used by many doctors.

There are no FDA-approved drugs to treat primary progressive multiple sclerosis, although research is ongoing. Instead, treatment centers on:

  • Managing symptoms
  • Maintaining quality of life

Drugs can be prescribed that help reduce symptoms such as:

  • Muscle tightness
  • Bladder and bowel problems
  • Pain
  • Fatigue

Rehabilitation can help with:

  • Speech
  • Swallowing problems
  • Performing daily activities and job functions

Diet and Exercise

Maintaining your overall health is important no matter which type of MS you have. There are no specific diets to help treat MS. But doctors recommend a healthy, nutritious diet. You should also try to maintain a healthy weight.

Exercise is also helpful for all types of MS. It can help you:

  • Stay active and mobile
  • Manage symptoms
  • Control weight

Exercise can also help increase energy and boost mood. Try a combination of physical activity, such as:

  • Gentle aerobic activity
  • Range-of-motion exercises
  • Stretching and strengthening

Remember to start slowly. Avoid getting overheated if you are heat-sensitive. And never exercise to the point of fatigue because it will take much longer to recover.

No matter which type of MS you have, ask your doctor for a referral to a physical therapist or physiotherapist. He or she can help you build an exercise program that's right for you.

WebMD Medical Reference

Reviewed by Richard Senelick, MD on October 23, 2012
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