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Many people develop secondary progressive multiple sclerosis—or SPMS—as a progression of relapsing-remitting multiple sclerosis (RRMS). When that happens, you spend less time in relapses, but your overall condition gradually worsens.
Secondary progressive MS is a form of MS that occurs after a patient already has RRMS. At some point in the disease progression, the disease becomes less inflammatory, but the nerve cells become progressively more damaged. As a result, your overall function declines, even when you aren't experiencing MS flare-ups. This leads to increasing disability over time.
The cause of MS isn't well understood in general. Likewise, the exact cause of SPMS isn't known, but most people with RRMS will develop SPMS eventually.
In this context, "secondary" means "developing after a person already has MS." It's only possible to diagnose secondary progressive multiple sclerosis in people who already have RRMS, but it's unclear exactly what causes the transition from one condition to the other.
There's another form of MS called "primary progressive MS." Compared to secondary progressive MS, it presents with the same degenerative symptoms but occurs spontaneously in people who don't already have RRMS. Here, "primary" means, "occurring first."
When diagnosing and treating SPMS, doctors make a distinction between active and non-active forms:
The terms "with progression" and "without progression" describe the evolution of physical disability in the patient. SPMS with progression means that disability is increasing over time, while SPMS without progression indicates that your level of experienced disability is relatively stable.
The "active/non-active" and "with/without progression" descriptors are independent of each other. As a result, secondary progressive multiple sclerosis can follow four different courses:
Each person's experience with MS is different. During your life, you'll probably move between these different courses. There may be periods where your condition is stable (your disability isn't worsening, nor are you experiencing symptoms), but there will also be relapses and periods where disability increases.
Overall, the disease will get worse with time, but the exact route you take through symptoms and disability progression is highly individualized.
The symptoms of SPMS are similar to those of RRMS, which it develops from. There's no "standard" course for the disease, so the exact symptoms and disability progression vary from person to person. Common symptoms include:
SPMS can only be diagnosed in people who already have relapsing-remitting MS. If you stop experiencing the usual relapse-remission cycle and instead begin to experience gradual functional decline, you may have developed SPMS.
Your doctor can diagnose secondary progressive MS with tests such as an MRI scan and a spinal tap to evaluate the extent of the nerve damage. After your diagnosis with SPMS, you should have regular MRI scans to monitor the progression of the disease and discuss changes to your treatment depending on how your case is developing.
Unfortunately, there's still no cure for MS, including SPMS.
You'll usually continue to take your RRMS medication as long as it's effective. Studies show that people who have more frequent and severe relapses are more likely to develop SPMS, so continuing your medication may delay or prevent the transition to secondary progressive MS.
Once you've been diagnosed with SPMS, secondary progressive multiple sclerosis treatment depends on what disease course you're on. For example, if you have active SPMS, you may continue your RRMS medications for secondary progressive MS to control relapse activity.
Your treatment will also focus on rehabilitation and symptom management. Physical therapy, for example, can help you move better and remain more independent for a longer time.
Learn more about treatment options for multiple sclerosis.
Everyone's experience of SPMS is different. However, secondary progressive MS causes a gradual loss of function and independence over time.
Secondary progressive MS isn't "end-stage" in the same way that cancer is. People generally don't die from MS directly. However, there's no "third stage" of MS after you develop SPMS.
You'll go through ups and downs with your MS symptoms. You may have periods—even long periods—where your condition is stable. In these times, your disability doesn't worsen, and your symptoms may go into remission. However, once you have SPMS, your overall condition will gradually decline.
People with MS live, on average, about seven years less than the general population.
There's no firm answer. Everyone's experience with MS is different. Some people decline quickly, while others remain stable for long periods.
For many, difficulty walking is one of the first signs they've transitioned from RRMS to SPMS. As your condition worsens, walking usually becomes more difficult. Depending on your MS progression, you may eventually need a cane, walker, or wheelchair.
SPMS can go into remission—periods where you aren't experiencing flare-ups—but it won't go away permanently.
The Multiple Sclerosis Center at Brigham and Women’s Hospital is internationally recognized for providing the most advanced treatment options for people with MS. Its expert care is strengthened by a leading clinical research program at the forefront of discovery.
You can schedule an appointment with our neurology team by calling鈥�617-525-6550鈥痮r by鈥�submitting a request through our secure online form.
What is multiple sclerosis (MS) and what are the symptoms of MS? Learn about testing and treatment options for MS, as well as the best ways to manage symptoms and future inflammatory relapses from Kristin M. Galetta, M.D., Neurologist, Brigham and Women’s Hospital, and Michael Levy, M.D., Ph.D., Neurologist, Massachusetts General Hospital.
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