Multiple Sclerosis (MS) is a disease that features several distinct patterns of increasing disability over time. One of the four most common disease courses, Secondary Progressive Multiple Sclerosis (SPMS), often comes after an MS patient has first been diagnosed with and suffered from a period of relapsing-remitting multiple sclerosis. While relapsing-remitting MS is characterized by a series of unpredictable attacks or flare-ups that subside into a remission state, the increasing disability pattern of secondary progressive MS becomes more steady over time, with flare-ups giving way to a steady increase in disability and loss of quality of life. It is estimated that about 90% of patients who are initially diagnosed with relapsing-remitting MS will eventually see the disease develop into secondary progressive MS. Typically, the transition from relapsing-remitting MS to the secondary progressive form begins about ten years or more from the initial diagnosis, as this is when patients most often report changes in their symptoms and the arc of the severity of the disease. Though the chart at the left generalizes the progression of several types of MS, because the disease and the manner in which if affects patients is so variable, offering a diagnosis of Secondary Progressive MS can take six months or more, in order for physicians and patients to track the increasing symptoms and disability patterns.
Secondary Progressive MS: Understanding The Patterns
While there is no pattern to predicting attacks in Relapsing-Remitting MS, the overall pattern of the disease type, which features an ongoing series of attacks and remission periods, is enough to differentiate it from other MS diagnoses, such as Primary Progressive Multiple Sclerosis, which features a steady progression of symptoms and disability from the start of the disease. As Relapsing-Remitting MS has a definable pattern feature, patients are able to notice the shift to the progressive form of the disease as it has become palpable over the course of time, since there is no longer a “recovery” period from symptoms.
Symptoms & Diagnosis of SPMS
SPMS symptoms are not necessarily different from the symptoms that govern Multiple Sclerosis overall; the defining feature of the disease type is its shift in pattern. However, symptoms associated with Secondary Progressive MS include an increase in weakness and lack of coordination; stiff, tight leg muscles; loss of bowel and bladder control; and increased fatigue, depression, and problems thinking than before — all of which do not appear to come and go. As noted above, SPMS diagnosis is predicated on steady communication between patient and doctor, since the diagnosis is not made via a diagnosis assay, but rather through professional observation and tracking of the disease. While the diagnosis may seem subjective, updating a diagnosis from Relapsing-Remitting to Secondary Progressive is very important, since the approach to treatment may change as well. In order to get the most informed diagnosis for Secondary Progressive MS, doctors use the Kurtzke disability scale to aid the measurement of the disease progression.
Causes of Secondary Progressive MS
One of the key areas of research for MS is an understanding of why Relapse-Remitting Multiple Sclerosis eventually progresses into Secondary Progressive MS in so many cases, as the cause of this is still largely unknown. Early theories suggested that the progression was linked with increased immune responses — an idea that has since given way to a more plausible theory that the progression of the disease may be a result of nerve damage or loss. Researchers believe that bringing to light a better understanding of the progression of MS will ultimately lead to improved treatments in the future.
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Treatment of Secondary Progressive MS
While the use of interferon and disease modifying drugs (DMDs) — the central class of medication for multiple sclerosis – are typically used to treat and decrease the intensity of attacks in the Relapsing-Remitting form of MS, these types of drugs have not been found to be effective in reducing symptoms in those with Secondary Progressive MS, since the disease in this form is no longer characterized in large part by relapses. To date, few viable treatment options exist. Currently, there is only one drug approved by the US Food and Drug Administration (FDA) for the treatment of SPMS, Novantrone (mitoxantrone). This disease modifying drug is mainly used to curtail relapses and has not shown much promise in offering relief to the steady increase of visibility in SPMS. More importanly, Novantrone carries a black box warning due to possible cardiotoxicity and other severe sides effects. Symptoms of secondary progressive MS can also be treated with methotrexate, an immune-suppressing drug used to treat rheumatoid arthritis. However, the medical community is still looking to current research in order to find a viable Secondary Progressive MS Treatment.