What Is Secondary Progressive Multiple Sclerosis?

If your doctor says you have secondary progressive multiple sclerosis (SPMS), it means you're in a different stage of your disease. Most folks get it after living for a while with relapsing-remitting MS (RRMS).

In SPMS, you may not get any break in your symptoms, unlike RRMS, when you had flare-ups that came and went. But your doctor can suggest medicine to help manage them.

Secondary vs. Relapsing-Remitting MS

About 85% of people with MS start with the relapsing-remitting form. They get attacks of symptoms called relapses, followed by symptom-free periods called remissions.

During relapses, your immune system -- your body's defense against germs -- causes inflammation that damages the protective coating around nerve fibers. This disrupts the flow of nerve signals to and from the brain and spinal cord. It leads to symptoms like tiredness, numbness, and weakness.

Then the immune system stops attacking. Your symptoms improve or disappear, and you go into remission. Relapses and remissions alternate over time.

In SPMS, your symptoms steadily get worse instead of coming and going. You might still have relapses, but they don't happen as often.

What Causes SPMS?

It's not clear exactly why RRMS changes to SPMS. Some researchers think it happens because of nerve damage that occurred earlier in the disease.

Not everyone with the relapsing-remitting form of the disease will get SPMS. Doctors don't know for sure who will and who won't, and how quickly it will happen.

You're more likely to change to SPMS if:

  • You're older
  • You've lived with MS for a long time
  • You have a lot of nerve damage in your brain and spinal cord
  • You have frequent and severe relapses

When Do People Change to SPMS?

A small number of people start out with SPMS. They may have had RRMS first, but it wasn't diagnosed or their symptoms were too mild to notice.

Before disease-modifying drugs were available, half of people with RRMS changed to SPMS within 10 years.

New treatments have altered the course of MS. Today these drugs can slow MS and delay the move towards SPMS, although doctors don't know how much they delay it.


What to Expect

Once you have SPMS, your symptoms may steadily get worse, but how quickly this happens differs from person to person.

You might also have the occasional relapse. After a relapse, your recovery won't be as complete as it used to be.

Your doctor will describe your SPMS based on how active your disease is:

  • Active. You are in a relapse or you have new symptoms.
  • Stable. You don't have new symptoms.
  • Active-progressing. You have relapses, and your symptoms are getting worse.
  • Non-active progressing. No relapses, but your symptoms are getting worse.

Whichever kind of SPMS you have, your doctor will discuss treatments with you to manage your disease and control your symptoms.

WebMD Medical Reference Reviewed by Christopher Melinosky on August 20, 2019



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Neurology: "Predictors of conversion to secondary progressive multiple sclerosis (P2.393)."

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